Unexpected Finding of a Small Intestinal Neuroendocrine Tumor: A Case Report and Literature Review.

BACKGROUND The incidence of neuroendocrine tumors (NETs) has increased in recent years. They can affect every area of the human body that presents cells with a secretory function. In this report, we focus on gastrointestinal NETs. The small bowel (SI) is the most affected area and SI-NETs have recently become more common than adenocarcinomas. Inside the small intestine, the appendix suffers from this pathology more than other organs. CASE REPORT Our case report deals with a 70 years-old man with extensive abdominal pain due to ingestion of an apricot kernel. A CT abdominal scan showed, around the kernel, a mechanical ileus with inflammation of the distal ileum and thickening of the intestinal wall. During the operation, we replaced laparoscopy with mini-laparotomy, performing an ileocecectomy due to suspicion of a tumor lesion. The histopathological exam revealed a well-differentiated neuroendocrine tumor (NET G1) of the distal ileum. CONCLUSIONS This case report shows that SI-NETs can be found in cases of small bowel occlusion. Depending on the size and distinction, such patients can have good survival rates.

Laparoscopic versus open restoration of intestinal continuity after Hartmann procedure.

BACKGROUND/AIMS: To present the initial experience with laparoscopic technique of restoration after Hartmann procedure compared to open surgery. METHODOLOGY: All patients submitted to Hartmann procedure from 2003 to 2008 were considered. The following parameters were evaluated: age, gender, comorbidities, American Society of Anesthesiologists score, indication for the procedure, Hinchey scale, interval between Hartmann and reversal procedure, total operative time of Hartmann reversal, pain management, delay in renewal of peristalsis, start of alimentation, length of hospital stay, morbidity, and mortality. RESULTS: Six patients were divided into groups A and B. Patients in group A underwent open Hartmann reversal and patients in group B underwent laparoscopic Hartmann reversal. Mean operative time was 136,6 min for group A and 95,6 min for group B. Mean postoperative duration of nasogastric tube placement was 2 days for group A and 1 day for group B. Group B showed a earlier return of bowel function and earlier restart of alimentation. Group B had shorter length of stay. There was no mortality or morbidity. CONCLUSIONS: Laparoscopic approach showed a shorter mean postoperative nasogastric tube time of placement and a shorter mean hospital stay, with faster resumption of bowel movements and early solid diet alimentation.