Unusual presentation of jejunal carcinoid tumor with intussusception and vertebral metastasis: a case report.

BACKGROUND: Jejunal carcinoid tumors are rare neuroendocrine neoplasms that often present with nonspecific abdominal symptoms, resulting in delayed diagnosis. Intussusception is an uncommon complication in adults, and skeletal metastases at initial presentation are exceedingly rare. To our knowledge, this is the first reported case of a jejunal carcinoid tumor presenting simultaneously with jejuno-jejunal intussusception and skeletal metastases involving the axial skeleton.

CASE PRESENTATION: A 48-year-old man presented with one week of recurrent colicky abdominal pain, bilious vomiting, and constipation. His medical history was significant for chronic low back pain progressing to paraplegia, with imaging evidence of vertebral metastases identified two years earlier. Contrast-enhanced computed tomography demonstrated jejuno-jejunal intussusception with proximal bowel dilatation and mixed sclerotic-lytic lesions of the axial skeleton. After preoperative stabilization, laparoscopic localization followed by laparotomy was performed, with resection of a 40-cm jejunal segment containing a circumferential mass acting as the lead point. A side-to-side stapled anastomosis was fashioned. The postoperative course was uneventful. Histopathological examination revealed a high-grade neuroendocrine neoplasm with a mitotic index >20 per high-power field. Postoperative PET imaging showed no residual disease at the primary site but confirmed skeletal metastases. Systemic therapy with somatostatin analogues and multidisciplinary oncologic follow-up were recommended.

CONCLUSIONS: This case illustrates an unusual presentation of a jejunal carcinoid tumor complicated by jejuno-jejunal intussusception and skeletal metastases. Recognition of such atypical metastatic patterns may facilitate earlier diagnosis and more appropriate management. Jejunal neuroendocrine tumors should be considered in the differential diagnosis of adult intussusception, particularly in the presence of unexplained skeletal lesions, with surgical resection remaining central to management.