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Background <p>Primary mesenteric neuroendocrine tumours (NETs) are an extremely rare subset of neuroendocrine neoplasms with unique diagnostic and therapeutic considerations. Accurate diagnosis requires a multidisciplinary approach integrating clinical, radiological, and histopathological evaluation. Surgical resection remains the mainstay of treatment and may be performed with or without bowel resection. The need for adjuvant therapy and follow-up is similar to that for other gastrointestinal NETs.</p> Case Presentation <p>A 51-year-old gentleman presented to the Surgical Gastroenterology outpatient department with a history of dull, aching central abdominal pain for 2–3 months. Clinical examination and laboratory parameters were unremarkable. Initial ultrasonography was inconclusive. Contrast-enhanced computed tomography (CECT) of the abdomen revealed a well-defined iso-dense lesion measuring approximately 4.3 × 4.8&#xa0;cm in the mesentery, with homogeneous enhancement, suggestive of a primary mesenteric NET. This was further supported by ⁶⁸Ga-DOTATATE PET-CT. The patient underwent exploratory laparotomy, and the lesion was excised en-bloc with surrounding mesentery while preserving the bowel and its vascular arcade. The postoperative course was uneventful. Histopathological examination confirmed a well-differentiated Grade 2 NET (WHO 2019 classification) with 2/10 lymph nodes positive and a Ki-67 index of 5–8%. Surgical margins were negative (&gt; 10&#xa0;mm).</p> Discussion <p>Primary mesenteric NETs are exceptionally rare, with limited cases reported in the literature. Patients often present with vague abdominal symptoms or are diagnosed incidentally on imaging. Surgery remains the cornerstone of treatment and may be performed via open or minimally invasive approaches, depending on tumour characteristics and anatomical relationships.</p> Conclusion <p>This case highlights the importance of advanced imaging in defining tumour extent and vascular relationships, enabling complete excision with negative margins while preserving bowel integrity. Bowel-sparing resection may contribute to faster recovery and favourable outcomes. Long-term surveillance remains essential due to the potential for disease progression.</p>

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Bowel Sparing Resection of a Primary Mesenteric Neuroendocrine Tumour – A Case Report

  • 期刊论文

  • 发表日期：

    2026年6月18日

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  • Venugopal H.G,
  • Mukund Mangarai

摘要

Background

Primary mesenteric neuroendocrine tumours (NETs) are an extremely rare subset of neuroendocrine neoplasms with unique diagnostic and therapeutic considerations. Accurate diagnosis requires a multidisciplinary approach integrating clinical, radiological, and histopathological evaluation. Surgical resection remains the mainstay of treatment and may be performed with or without bowel resection. The need for adjuvant therapy and follow-up is similar to that for other gastrointestinal NETs.

Case Presentation

A 51-year-old gentleman presented to the Surgical Gastroenterology outpatient department with a history of dull, aching central abdominal pain for 2–3 months. Clinical examination and laboratory parameters were unremarkable. Initial ultrasonography was inconclusive. Contrast-enhanced computed tomography (CECT) of the abdomen revealed a well-defined iso-dense lesion measuring approximately 4.3 × 4.8 cm in the mesentery, with homogeneous enhancement, suggestive of a primary mesenteric NET. This was further supported by ⁶⁸Ga-DOTATATE PET-CT. The patient underwent exploratory laparotomy, and the lesion was excised en-bloc with surrounding mesentery while preserving the bowel and its vascular arcade. The postoperative course was uneventful. Histopathological examination confirmed a well-differentiated Grade 2 NET (WHO 2019 classification) with 2/10 lymph nodes positive and a Ki-67 index of 5–8%. Surgical margins were negative (> 10 mm).

Discussion

Primary mesenteric NETs are exceptionally rare, with limited cases reported in the literature. Patients often present with vague abdominal symptoms or are diagnosed incidentally on imaging. Surgery remains the cornerstone of treatment and may be performed via open or minimally invasive approaches, depending on tumour characteristics and anatomical relationships.

Conclusion

This case highlights the importance of advanced imaging in defining tumour extent and vascular relationships, enabling complete excision with negative margins while preserving bowel integrity. Bowel-sparing resection may contribute to faster recovery and favourable outcomes. Long-term surveillance remains essential due to the potential for disease progression.