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Sonographic features show dilated small bowel loop with absent peristalsis. Also depicted are increased intraluminal secretions within the ischemic small bowel segment (white arrow), slight mural thickening and intramural gas (black arrows).
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Neuroendocrine tumors represent a heterogeneous group of neoplasms that arise from neuroendocrine cells and secrete various peptides and bioamines. While gastrointestinal neuroendocrine tumors, commonly called carcinoids, account for about 2/3 of all neuroendocrine tumors, they are relatively rare. Small intestine neuroendocrine tumors originate fr...
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Context 1
... x-ray demonstrated a dilated small bowel loop with intestinal pneumatosis (Figure 1). This was also confirmed in an ultrasound exam, during which the affected loop was found to be slightly thickened, with no peristalsis and with intraluminal content and intestinal wall pneumatosis (Figure 2). The intramural gas pattern, along with the presence of fluid in the Douglas pouch, raised the suspicion of mesenteric ischemia. ...
Citations
... 34 These are the second most common malignant tumors of the small bowel (20-25% of malignant tumors). 46 One-third of GNETs originate from the small bowel. 47 Ileum is the most common site of involvement. ...
Small bowel tumors are rare with nonspecific and protean clinical presentation. Early diagnosis of small bowel tumors is desirable as they can be associated with significant morbidity. In malignant small bowel tumors, delayed diagnosis may result in dissemination and metastasis leading to poor clinical outcomes. Imaging evaluation of small bowel can be challenging due to unpredictable luminal distension, peristalsis, and motion. In addition, the lack of distinction between the intraluminal lesions and intraluminal contents can be difficult at times. Computed tomography (CT) and magnetic resonance (MR) enterography are the most common imaging techniques for the evaluation of small bowel tumors. While these techniques may not be able to detect small tumors, they provide comprehensive evaluation of lumen, wall, and extramural structures in tumors more than 2 cm. Acquaintance of imaging appearance of common benign and malignant small bowel tumors may allow improved detection during evaluation of CT and MR enterography studies. In this review, we discuss the imaging appearances, approach, and differential diagnosis of small bowel tumors on cross-sectional imaging studies.
... In that case, the patient complained of nonspecific symptoms for about one year before manifesting with acute mesenteric ischemia, and abdominal X-rays revealed pneumatosis intestinalis and an abdominal ultrasound and computed tomography confirmed the diagnosis. The patient was submitted to a segmental enterectomy [19]. ...
Neuroendocrine tumors (NETs) are considered the most frequent tumors that affect the small bowels. Despite diagnostic modalities, the diagnosis of small bowel NETs is not straightforward and poses a high challenge to most physicians, due to poor accessibility to this area and the patient's non-specific presentations. We reported a case of a 60-year-old male patient, who presented with severe postprandial epigastric pain of one-month duration, loss of appetite, and weight loss. Investigations revealed no definite diagnosis. Therefore, exploratory laparoscopy was attempted along with multiple biopsies that led to the diagnosis of small bowel NET. We conclude that NETs require a high index of suspicion in patients with recurrent abdominal pain.
... Usually, diagnosis of NET is delayed due to their small size and unspecific symptoms. Manifestations include abdominal pain, gastrointestinal bleeding, and intestinal obstruction, as well as symptoms secondary to metastasis, carcinoid syndrome, or anemia [2] [4]. Variable presentation leads clinicians to initially consider other diagnoses. ...
... Results may be better with a laparotomy, since it allows exploration of all the small intestine by palpation, and it also guarantees appropriate node resection. This clinical case combined that approach with video-assistance, allowing proper exploration and tumor resection [4]. ...
... A minimum of 7 nodes includes those in group 1 (peri-intestinal nodes), group 2 (mesenteric nodes), and group 3 (mesenteric root nodes). 3) In case of metastatic liver disease, metastasis resection may be considered [4] [19]. ...
... Another cause of bowel ischemia can be local vascular obstruction due to tumor compression, which can manifest as acute ischemia [101]. Beyond the visualization of the ischemic bowel wall, dual-energy imaging allows for quantitative assessment of iodine uptake (Fig. 15). ...
Acute bowel ischemia is a condition with high mortality and requires rapid intervention to avoid catastrophic outcomes. Swift and accurate imaging diagnosis is essential because clinical findings are commonly nonspecific. Conventional contrast enhanced CT of the abdomen has been the imaging modality of choice to evaluate suspected acute bowel ischemia. However, subtlety of image findings and lack of non-contrast or arterial phase images can make correct diagnosis challenging. Dual-energy CT provides valuable information toward assessing bowel ischemia. Dual-energy CT exploits the differential X-ray attenuation at two different photon energy levels to characterize the composition of tissues and reveal the presence or absence of faint intravenous iodinated contrast to improve reader confidence in detecting subtle bowel wall enhancement. With the same underlying technique, virtual non-contrast images can help to show non-enhancing hyperdense hemorrhage of the bowel wall in intravenous contrast-enhanced scans without the need to acquire actual non-contrast scans. Dual-energy CT derived low photon energy (keV) virtual monoenergetic images emphasize iodine contrast and provide CT angiography-like images from portal venous phase scans to better evaluate abdominal arterial patency. In Summary, dual-energy CT aids diagnosing acute bowel ischemia in multiple ways, including improving visualization of the bowel wall and mesenteric vasculature, revealing intramural hemorrhage in contrast enhanced scans, or possibly reducing intravenous contrast dose.
Graphic abstract
... 2) En los tumores con metástasis a distancia: resección paliativa más linfadenectomía regional, con quimioterapia previa, para reducir la lesión, y/o posterior, si es que la resección no ha sido completa y 3) En los casos de invasión a órganos adyacentes y en complicaciones: hemicolectomía derecha, izquierda o transversa, dependiendo del compromiso del drenaje linfático observado en la cirugía. (8,9) En relación al caso presentado el manejo se realizó con una resección del tumor con criterio oncológico, a pesar de tratarse de una cirugía de emergencia, en el postoperatorio la estadificación del paciente correspondían a un estadio IIIA (T4, N1, MX)), con lo cual se aseguró que no sea necesario una nueva intervención y mejorando el pronóstico de sobrevida del paciente (7,9) . Según la bibliografía presentada, si existen elementos de riesgo, debe evaluarse la cirugía radical en pacientes con un riesgo quirúrgico adecuado. ...
... 2) En los tumores con metástasis a distancia: resección paliativa más linfadenectomía regional, con quimioterapia previa, para reducir la lesión, y/o posterior, si es que la resección no ha sido completa y 3) En los casos de invasión a órganos adyacentes y en complicaciones: hemicolectomía derecha, izquierda o transversa, dependiendo del compromiso del drenaje linfático observado en la cirugía. (8,9) En relación al caso presentado el manejo se realizó con una resección del tumor con criterio oncológico, a pesar de tratarse de una cirugía de emergencia, en el postoperatorio la estadificación del paciente correspondían a un estadio IIIA (T4, N1, MX)), con lo cual se aseguró que no sea necesario una nueva intervención y mejorando el pronóstico de sobrevida del paciente (7,9) . Según la bibliografía presentada, si existen elementos de riesgo, debe evaluarse la cirugía radical en pacientes con un riesgo quirúrgico adecuado. ...
Neuroendocrine carcinoma (NEC) of the colon is a rare and very aggressive tumor, generally diagnosticated in an incidental way and during resolution of complications such as perforation or intestinal obstruction. The case of a 58-year-old male patient who was surgically intervened for presenting localized peritonitis pedhora scan to a perforated blind neuroendocrine tumor. Right hemicolectomy whit ganglion D2 resection and ileo – transverse primary anastomosis was performed. Histopathological examination described a well-differentiated neuroendocrine carcinoma of small cells, with no vascular or neuronal infiltration. Now the patient is awaiting chemotherapy without the need for secondary surgical review.
... Particularly important is the fact that there is a percentage of colonic adenocarcinomas which have a small percentage of neuroendocrine characteristics that are believed to negative affect the prognosis 4,9,12 . More research is required to determine both the diagnostic criteria, and the treatment regimens, since the current methods have disappointing results 11,18,21 . ...
Neuroendocrine carcinoma (NEC) of the colon is a rare and very aggressive tumor with poor prognosis. The current case report presents a 53-year-old male with a 6 cm × 10 cm ascending colon carcinoma, causing large intestine obstruction, with simultaneous multiple hepatic metastases and peritoneal carcinomatosis. Surgical resection of the primary tumor was performed, because of the bowel obstruction, to ameliorate the symptoms before the onset of chemotherapy. Histopathology revealed that the tumor was a small-cell undifferentiated NEC. During the post0operative period, the patient presented pulmonary metastases, and on the 36th post-operative day, death occurred due to respiratory failure.
... 30 Fibrosis of small bowel mesentery and the peritoneum is thought to be a desmoplastic reaction to mesenteric lymph node metastasis. 28,29 Peritoneal metastasis can produce local fibrosis with the consequence of mesenteric ischemia 31 and retroperitoneal fibrosis, presenting with abdominal mass and ureteral obstruction. ...
Neuroendocrine neoplasms (NENs) are derived from neuroendocrine cell system and can have benign or malignant characteristics. They are rare tumors, but have been increasing in incidence over the past 40 years. Patients with NENs may develop symptoms due to primary tumor invasion, metastasis, or from secretion of hormonally active tumor substances. Multiple imaging modalities are used for diagnosis and staging, including specialty scans such as ¹¹¹ In pentetreotide (Octreoscan) and ⁶⁸ Gallium-DOTATATE, along with endoscopy, endoscopic ultrasound, and biochemical marker testing. Treatment involves both surgical approach, for both primary and metastatic lesions, as well as medical management for symptom management and disease progression. This article will review the current clinical knowledge regarding the diagnosis, treatment, and prognosis of these fascinating neoplasms and the associated hormonal syndromes.
... Well-differentiated neuroendocrine tumors (carcinoid tumors) originate from enterochromaffin cells within the gastro-entero-pancreatic and bronchopulmonary systems [36]. Gastrointestinal neuroendocrine tumors are rare in the general population, representing approximately 0.5% of all human cancers [37]. Reported as the second most common malignancy of the small bowel, neuroendocrine tumors account for approximately 20-25% of malignant neoplasms [38]. ...
Although the small intestine accounts for over 90% of the surface area of the alimentary tract, tumors of the small intestine represent less than 5% of all gastrointestinal tract neoplasms. Common small bowel tumors typically are well evaluated with cross-sectional imaging modalities such as CT and MR, but accurate identification and differentiation can be challenging. Differentiating normal bowel from abnormal tumor depends on imaging modality and the particular technique. While endoscopic evaluation is typically more sensitive for the detection of intraluminal tumors that can be reached, CT and MR, as well as select nuclear medicine studies, remain superior for evaluating extraluminal neoplasms. Understanding the imaging characteristics of typical benign and malignant small bowel tumors is critical, because of overlapping features and associated secondary complications.
... Во-первых, наличие первичной опухоли является фактором, оказывающим негативное влияние на прогноз течения заболевания у больных с генерализованными НЭО [26,27]. Вовторых, в связи с бóльшей продолжительностью жизни больных с НЭО существует высокий риск развития осложнений опухолевого процесса в виде кишечной непроходимости, кровотечения, нарушения кровоснабжения пораженного сегмента тонкой кишки [28]. Результаты проведенного нами исследования также подтверждают целесообразность активной хирургической тактики у больных с генерализованными НЭО тонкой кишки, что позволило увеличить их выживаемость в 1,7 раза. ...
The OBJECTIVE of the study was to clarify the rational program of diagnosis and choice of treatment tactics for patients with neuroendocrine tumors (NET) of the small intestine, taking into account their clinical and morphological characteristics. MATERIAL AND METHODS. We studied the results of examination and treatment of 39 patients. RESULTS. CT is the main method of topical diagnosis, the sensitivity of which in the detection of NET of the small intestine is 96.4 %. Sign of the localization of NET in the small intestine is the tumor conglomerate of its mesentery, which includes diffuse-infiltrative and nodular variant of changes. The diffuse-infiltrative variant of tumor conglomerate is characterized by increased risk of complicated course of tumor process. Cytoreductive surgical treatment allows to increase the survival rate of patients with generalized NET of the small intestine in 1.7 times. CONCLUSION. Treatment of patients with NET of the small intestine should be carried out in specialized medical centers that have the ability to implement a multidisciplinary approach that can significantly increase the duration and quality of life of patients.
... Particularly important is the fact that there is a percentage of colonic adenocarcinomas which have a small percentage of neuroendocrine characteristics that are believed to negative affect the prognosis 4,9,12 . More research is required to determine both the diagnostic criteria, and the treatment regimens, since the current methods have disappointing results 11,18,21 . ...
Neuroendocrine carcinoma (NEC) of the colon is a rare and very aggressive tumor with poor prognosis. The current case report presents a 53-year-old male with a 6 cm × 10 cm ascending colon carcinoma, causing large intestine obstruction, with simultaneous multiple hepatic metastases and peritoneal carcinomatosis. Surgical resection of the primary tumor was performed, because of the bowel obstruction, to ameliorate the symptoms before the onset of chemotherapy. Histopathology revealed that the tumor was a small-cell undifferentiated NEC. During the post0operative period, the patient presented pulmonary metastases, and on the 36th post-operative day, death occurred due to respiratory failure.
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