El Bakouri Abdelilah, El Wassi Anas, Eddaoudi Yassine, Bouali Mounir, El Hattabi Khalid, Bensardi Fatimazahra, Fadil Abdelaziz
Visceral Surgery Emergency Department P35, University Hospital Center Ibn Rochd, Casablanca, Morocco.
Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
Ann Med Surg (Lond). 2022 Sep 22;82:104735. doi: 10.1016/j.amsu.2022.104735. eCollection 2022 Oct.
Neuroendocrine tumors of the small bowel are rare but represent the most frequent histological type at this level; their incidence is increasing thanks to the evolution of diagnostic means.Intestinal NETs, developed at the expense of enterochromaffin cells of the embryological midgut, are frequently associated with mesenteric lymph node dissemination and distant metastasis (liver, peritoneum).
We report a case of Incidental discovery of a small bowel neuroendocrinetumor during appendicular peritonitis in the department of Emergency visceral surgery P35 of the ibn rochd hospital in casablanca.
Our patient Our patient was admitted to the emergency room for generalized abdominal pain with an appendicular symptomatology evolving five days before days the consultation with clinical examination: conscious patient stable on the hemodynamic and respiratory plan The examination noted generalized abdominal defense the hernial orifices were free The biological work-up revealed a hb 13 g/dL; hyperleukocytosis with predominantly PNN at 18,300 elements/mm3,CRP was elevated to 190, renal function was normal urea 5 mmol/L creatinemia 9 mg/l an abdominal ultrasound showed a 9 mm appenndix perforated at its tip with moderate peritoneal effusion.the patient were operated in the emergency room, approached by laparotomy with the exploration we found a swollen and inflamed appenndix perforated at the level of its tip with moderate peritoneal effusion with false membranes in all the peritoneal cavity with the presence of a polyp localized at 2 m from the duodenojejunal flexur .the patient benefited from a retrograde appendectomy with peritoneal cleansing and a resection of the polyp with 1cm on each side with a Grele-grele anastomosis with the examination of the anapathomopathologist: aspect compatible with a well differentiated neuroendocrine tumor of grade 2.
Digestive NETs are rare tumors, but their incidence has increased significantly in recent years. This is due to a better knowledge of these tumors, whose diagnosis is becoming easier with the advent of new morphological and biological techniques.The intestinal location is the most frequent. The digestive surgeon must therefore be familiar with its management. An update of knowledge and collaboration between surgeons, anatomopathologists, radiologists and oncologists are necessary, Whatever their location, these tumors are on the one hand capable of producing and secreting amines and on the other hand they are characterized by a common phenotype, expression of general endocrine markers (specific neuron enolase, chromogranin) or specific endocrine markers and expression of peptide receptors such as somastotatin receptors.These tumors are most often diagnosed incidentally during the workup of aspecific digestive disorders or during hormonal hypersecretion syndrome or rarely by a complication.
小肠神经内分泌肿瘤较为罕见，但却是该部位最常见的组织学类型；由于诊断手段的进步，其发病率正在上升。肠道神经内分泌肿瘤起源于胚胎中肠的肠嗜铬细胞，常伴有肠系膜淋巴结转移和远处转移（肝脏、腹膜）。
我们报告了一例在卡萨布兰卡伊本·罗什德医院急诊内脏外科P35科室因阑尾腹膜炎偶然发现小肠神经内分泌肿瘤的病例。
我们的患者因全身腹痛被收入急诊室，阑尾症状在就诊前五天出现，临床检查时病情发展：患者意识清醒，血流动力学和呼吸状况稳定。检查发现全腹压痛，疝孔无异常。实验室检查显示血红蛋白13g/dL；白细胞增多，以中性粒细胞为主，达18300个/mm³，C反应蛋白升高至190，肾功能正常，尿素5mmol/L，肌酐9mg/l。腹部超声显示阑尾尖端9mm穿孔，伴有中度腹腔积液。患者在急诊室接受手术，通过剖腹探查发现阑尾肿胀发炎，尖端穿孔，伴有中度腹腔积液，整个腹腔有假膜，在距十二指肠空肠曲2m处有一个息肉。患者接受了逆行阑尾切除术并进行腹腔清洗，息肉两侧各切除1cm，行端端吻合，经病理学家检查：形态符合2级高分化神经内分泌肿瘤。
消化系神经内分泌肿瘤是罕见肿瘤，但近年来其发病率显著上升。这归因于对这些肿瘤有了更好的认识，随着新的形态学和生物学技术的出现，其诊断变得更加容易。肠道部位最为常见。因此，消化外科医生必须熟悉其治疗方法。外科医生、解剖病理学家、放射科医生和肿瘤学家之间的知识更新与合作是必要的。无论其位置如何，这些肿瘤一方面能够产生和分泌胺类物质，另一方面它们具有共同的表型，表达一般内分泌标志物（特异性神经元烯醇化酶、嗜铬粒蛋白）或特异性内分泌标志物以及肽受体如生长抑素受体的表达。这些肿瘤最常在非特异性消化系统疾病检查、激素分泌过多综合征期间偶然被诊断出来，或很少因并发症而被诊断。
