Bronchospasm Complicating A Small Intestine Neuroendocrine Tumor Resection: A Case Report : Case Report

BACHAR Amine

doi:10.58372/2835-6276.1144

Authors

BACHAR Amine

DOI:

https://doi.org/10.58372/2835-6276.1144

Keywords:

Small intestinal neuroendocrine tumors, SI-NETs, carcinoid syndrome, bronchospasm, surgical resection, perioperative management

Abstract

Small intestinal neuroendocrine tumors (SI-NETs) are rare neoplasms with increasing incidence, known for their diverse clinical presentations and potential hormonal complications. We present the case of a 65-year-old male with a history of chronic smoking and alcoholism, who presented with right iliac fossa pain, liquid diarrhea, and weight loss. Imaging revealed a neuroendocrine tumor of the small intestine, and the patient underwent surgical resection. However, postoperatively, he developed respiratory distress suggestive of bronchospasm, requiring intensive care management. Histopathological analysis confirmed a well-differentiated neuroendocrine tumor, Grade 2. This case underscores the importance of early recognition and management of hemodynamic complications following surgical resection of SI-NETs. Preoperative assessment for carcinoid syndrome and optimization of cardiac function are crucial to minimize perioperative risks. Surgical resection with meticulous attention to complete tumor removal and mesenteric dissection remains the mainstay of treatment for SI-NETs. Further research is needed to refine perioperative management strategies and improve long-term outcomes for patients with SI-NETs.

References

Yao JC, Hassan M, Phan A et al (2008) One hundred years after ‘‘carcinoid’’: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 26:3063–3072

Mitry E. Tumeurs neuroendocrines digestives. EMC - Gastro-entérologie 2013;8(4):1-13 [Article 9-089-C-20].

Soga J: Carcinoids and their variant endocrinomas. An analysis of 11,842 reported cases. J Exp Clin Cancer Res 2003; 22: 517–530.

Yao JC, Hassan M, Phan A, et al. One hundred years after ‘carcinoid’: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol2008; 26: 3063–3072.

Kaltsas GA, Besser GM and Grossman AB. The diagnosis and medical management of advanced neuroendocrine tumors. Endocr Rev2004; 25: 458–511.

Niederle B, Pape UF, Costa F, et al. ENETS Consensus Guidelines update for neuroendocrine neoplasms of the jejunum and ileum. Neuroendocrinology 2016; 103: 125–138.

Landry CS, Lin HY, Phan A, et al. Resection of at-risk mesenteric lymph nodes is associated with improved survival in patients with small bowel neuroendocrine tumors. World J Surg 2013; 37: 1695–1700.

Daskalakis K, Karakatsanis A, Hessman O, et al. Association of a prophylactic surgical approach to stage IV small intestinal neuroendocrinetumors with survival. JAMA Oncol 2018; 4: 183–189.

Moller JE, Pellikka PA, Bernheim AM, et al. Prognosis of carcinoid heart disease: analysis of 200 cases over two decades. Circulation 2005; 112: 3320–3327.

Howe JR, Cardona K, Fraker DL, et al. The Surgical Management of Small Bowel Neuroendocrine Tumors: ConsensusGuidelines of the North American Neuroendocrine Tumor Society. Pancreas. 2017;46(6):715–731.

Condron ME, Jameson NE, Limbach KE, et al. A prospective study of the pathophysiology of carcinoid crisis. Surgery. 2019;165(1):158–165. 12.

Massimino K, Harrskog O, Pommier S, Pommier R. Octreotide LAR and bolus octreotide are insufficient for preventing intraoperative complications in carcinoid patients. J Surg Oncol. 2013;107(8):842–846.

Woltering EA, Wright AE, Stevens MA, et al. Development of effective prophylaxis against intraoperative carcinoid crisis. J Clin Anesth. 2016;32:189–193.

Kinney MA, Warner ME, Nagorney DM, et al. Perianaesthetic risks and outcomes of abdominal surgery for metastatic carcinoid tumours. Br J Anaesth. 2001;87(3):447–452.

Skertich NJ, Gerard J, Poirier J, et al. Do All Abdominal Neuroendocrine Tumors Require Extended Postoperative VTE Prophylaxis? A NSQIP Analysis. J Gastrointest Surg. 2019;23(4):788–793.

Blanchin M, James-Deidier A, Chaumet-Riffaud PD, Chayvialle JA. Use of octreotide in the treatment of digestive endocrine tumors. A French multicenter study. Presse Med 1992;21:697–702.

Mignon M. Natural history of neuroendocrine enteropancreatic tumors. Digestion 2000;62(Suppl. 1):51–8. 18.

Corcos O, O’Toole D, Ruszniewski P. Traitement antisecretoire des tumeurs endocrines. In: Baudin E, Ducreux M, editors. Tumeurs endocrines thoraciques et digestives. Paris: Springer; 2008. p. 195–213. 19.

Kinney MA, Warner ME, Nagorney DM, Rubin J, Schroeder DR, Maxson PM, et al. Perianaesthetic risks and outcomes of abdominal surgery for metastatic carcinoid tumours. Br J Anaesth 2001;87:447–52. 20.

Veall GR, Peacock JE, Bax ND, Reilly CS. Review of the anaesthetic management of 21 patients undergoing laparotomy for carcinoid syndrome [see comments]. Br J Anaesth 1994;72:335–41.

Capron F, Fialip S, Guitard I, Lasser P, Billard V. Prise en charge peranesthesique du syndrome carcinoide : apport de l’index bispectral de l’EEG. Ann Fr Anesth Reanim 2000;19:552–5.

Kulke MH, Mayer RJ. Carcinoid tumors. N Engl J Med 1999;340:858–68

Quinlivan JK, Roberts WA. Intraoperative octreotide for refractory carcinoid-induced bronchospasm. Anesth Analg 1994;78:400–2.

Nilsson O, Gronstad KO, Goldstein M, Skolnik G, Dahlstrom A, Ahlman H. Adrenergic control of serotonin release from a midgut carcinoid tumour. Int J Cancer 1985;36:307–12. 25. Holdcroft A. Hormones and the gut. Br J Anaesth 2000;85:58–68.