Multifocal small cell neuroendocrine carcinoma of the jejunum, ileum and caecum: A rare case with intestinal obstruction and perforation

Neuroendocrine tumours of the small intestine are sporadic and may be of large- or small-cell type. The ileum and jejunum are most frequently affected by this malignant neoplasm, which exhibits a high tendency towards multifocality and metastatic spread. Diagnosis is often delayed because symptoms are non-specific, such as pain, carcinoid syndrome, or anaemia. They typically occur around the age of 60 years and affect women more often than men. At diagnosis, they are frequently locally advanced with nodal involvement, leading to mesenteric fibrosis that can result in intestinal obstruction or perforation. We present the case of a 72-year-old man who, during the COVID-19 pandemic, presented with non-specific symptoms and underwent exploratory laparotomy, including partial resection of the terminal jejunum, ileum, and cecum, end-to-lateral ileocolonic anastomosis, and creation of a double-barrel jejunostomy. Multiple tumours were found in the small intestine and caecum. However, the outcome was poor due to disease progression. Neuroendocrine tumours should be considered in the differential diagnosis for colonic and small intestinal neoplasms, regardless of the patient’s age or sex. This case highlights the significant challenges faced by surgeons in managing complex, multifocal tumours.