An Unusual Cause of Mesenteric Ischemia of the Small Intestine: Jejunal Neuroendocrine Tumor

Small intestinal neuroendocrine tumors are rare gastrointestinal malignancies (< 0.5% of all cancers). Complications at presentation include bleeding, abdominal pain, and bowel obstruction; small bowel ischemia and bowel necrosis are rare. A 63-year-old patient was referred from a rural hospital to Acute Care Surgery with bowel obstruction, and arrived in septic shock. He was resuscitated, diagnosed with mesenteric ischemia, and underwent an exploratory laparotomy which identified an internal hernia (which was released), and small bowel ischemia and necrosis which were resected. The incidence of acute mesenteric ischemia < 0.2% of all acute surgical admissions. Nonocclusive mesenteric ischemia accounts for 20% of all etiologies and was evident in this case. The superior mesenteric artery pulse was clinically palpable and there were no signs intraoperatively of venous stasis at the root of the mesentery. Pathology confirmed multiple small bowel mesentery neuroendocrine tumor nodules. Surgical resection remains the mainstay of treatment.