Situs inversus totalis with ileal neuroendocrine tumour: A diagnostic and surgical challenge

Small intestine neuroendocrine tumours are becoming increasingly widespread, despite being a relatively rare condition. While abdominal computed tomography scans during routine check-up often detect small intestine neuroendocrine tumours, many cases are still diagnosed unexpectedly during emergency surgery. This subject is relevant because two rare conditions,situs inversus totalisand intestinal malrotation, can also affect the abdominal region thus misleading the diagnosis. The purpose of this study was to highlight the case of an acute onset of small bowel obstruction caused by neuroendocrine tumour with concomitant presence ofsitus inversus totalis.Situs inversus totalisusually stays asymptomatic, being discovered by chance during imaging, or manifests itself early in neonatal period with obstructive features or in old age as acute intestinal obstruction. However, this case is unique as the coexistence of situs inversus totalis and small intestine neuroendocrine tumours causing acute intestinal obstruction has not been previously reported in medical literature. The patient was diagnosed with a case ofsitus inversus totalis; when evaluated for cause of recurrent intestinal obstruction, the patient developed a fresh episode of acute intestinal obstruction while check-up was still ongoing and had to be taken up for emergency exploratory laparotomy. Patient underwent segmental small bowel resection and stapled side-to-side anastomosis. The real cause for recurrent obstructions was neuroendocrine tumour and not preoperatively presumed situs inversus totalis. Despite significant advancements in the treatment and management of small intestine neuroendocrine tumours, which improved patient outcomes, diagnosing these tumours continues to be a substantial challenge. This study aids in keeping a broader mindset on practical grounds, while concluding cause for intestinal obstruction in cases of multiple presumptions