Medical City Fort Worth Fort Worth, TX, United States
Thao T. Nguyen, DO1, Gabriel Gonzales, DO1, Sheila Rastegari, DO1, Timothy Dobin, DO1, Srujana Dasari, MD1, Long Hoang, DO2, Monte Troutman, DO2 1Medical City Fort Worth, Fort Worth, TX; 2UNT Health Science Center, Fort Worth, TX
Introduction: Neuroendocrine tumors (NETs) are a rare cancer of the gastrointestinal (GI) tract, accounting for less than 1% of all colorectal cancers. GI NETs are most commonly found in the small bowel and may be a completely asymptomatic incidental finding unless a patient presents with bowel obstruction or carcinoid syndrome. Here, we detail an unusual presentation of a patient who was eventually diagnosed with an ileocecal valve NET after presenting with clinical signs and symptoms concerning for inflammatory bowel disease (IBD).
Case Description/Methods: A 57-year-old Caucasian female with past medical history of iron deficiency anemia presented to our facility for acute constipation and crampy epigastric discomfort. Patient admitted to intermittent low-volume diarrhea episodes, denying symptoms of weight loss, hematochezia, or melena. Patient had a benign abdominal exam with a nonacute abdomen. A contrasted CT revealed a thickened distal ileum with focal narrowing and associated proximal small bowel dilation concerning for small bowel obstruction. Inflammatory markers were elevated, including a substantial elevation of calprotectin at 2630 µg/g. The patient was evaluated by surgery with recommendation to proceed with GI endoscopic evaluation for IBD. Her symptoms improved with nasogastric tube decompression. Subsequently, patient underwent EGD and colonoscopy, with findings remarkable for terminal ileitis and a significantly inflamed and stenosed ileocecal valve; no definite mass lesion was identified. Biopsies were surprisingly unremarkable. On outpatient follow up, a CT enterography (CTE) was obtained for evaluation of the small bowel given suspected Crohn’s disease. The CTE revealed a 3.7cm partially calcified ileocolonic mesenteric mass. Patient underwent exploratory laparotomy with right hemicolectomy for removal of the ileocecal mass. Histology was consistent with a grade 1, well-differentiated neuroendocrine tumor. On follow-up with oncology, a Ga-68 dotatate PET/CT scan did not reveal any evidence of a metastatic lesion.
Discussion: This case highlights the importance of a CTE in the workup of suspected Crohn’s disease and in patients presenting with bowel obstruction. In our patient, the CTE led to the eventual diagnosis of the ileocecal mass, which would have otherwise been missed and the presentation wholly attributed to IBD. This case also highlights the importance of establishing a broad differential for ileal disease, keeping in mind the rare conditions such as a neuroendocrine tumor.
Figure: Figure A and Figure B. Contrasted CT coronal image and axial image, respectively, showing abnormal course calcifications adjacent to the ileocecal valve and associated soft tissue component. (Outpatient CTE images unavailable); Figure C. Endoscopic images of the ileocecal valve showing inflammation and stenosis
Thao Nguyen indicated no relevant financial relationships.
Gabriel Gonzales indicated no relevant financial relationships.
Sheila Rastegari indicated no relevant financial relationships.
Timothy Dobin indicated no relevant financial relationships.
Srujana Dasari indicated no relevant financial relationships.
Long Hoang indicated no relevant financial relationships.
Monte Troutman indicated no relevant financial relationships.
Thao T. Nguyen, DO1, Gabriel Gonzales, DO1, Sheila Rastegari, DO1, Timothy Dobin, DO1, Srujana Dasari, MD1, Long Hoang, DO2, Monte Troutman, DO2. P0948 - Neuroendocrine Tumor of the Ileocecal Valve: An IBD Mimicker, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.