Recurrent Gastrointestinal Pseudo-obstruction Because of Well-Differentiated Duodenal Neuroendocrine Tumor

A 56-year-old man presented with recurrent gastrointestinal obstruction. Computed tomography showed fluid-filled, distended stomach, small intestine, and large intestine. Extensive workup including esophagogastroduodenoscopy, colonoscopy, magnetic resonance enterography, push enteroscopy, and video capsule enteroscopy showed no mechanical obstruction. Endoscopic ultrasound–guided biopsy of peripancreatic nodes detected on (18)F-fluorodeoxyglucose positron emission tomography revealed a duodenal neuroendocrine tumor. The lesion showed intense uptake on gallium-68 DOTATOC positron emission tomography-computed tomography scan. The patient underwent surgical resection of the tumor with resolution of bowel obstruction events. He had elevated pancreatic polypeptide levels, which are known to delay gastric emptying and could explain his symptoms.