Small bowel obstruction from metastatic small intestinal neuroendocrine tumor managed solely with somatostatin analog

Small intestinal neuroendocrine tumors (SI-NETs) are an uncommon cause of bowel obstruction and are often diagnosed at an advanced stage. When SI-NETs are diagnosed in older patients, clinicians often face challenges that limit the use of evidence-based therapeutic interventions. In the presented case, an older patient with poor functional status presented with bowel obstruction. A biopsy obtained by diagnostic laparoscopy confirmed well-differentiated metastatic NET. The patient was considered at high risk for surgery. The patient and her proxy preferred conservative management. A trial of somatostatin analog (SSA) resulted in the improvement of bowel obstruction symptoms and decreased the size of the tumor in subsequent imaging studies. This case demonstrates the utility of SSA as a primary therapeutic intervention for resolving small bowel obstruction in patients with SI-NETs who are poor surgical candidates.