Spontaneous rupture of a non-functioning pancreatic neuroendocrine tumor A case report of a rare cause of acute abdomen.

Background: Pancreatic neuroendocrine tumors (PNETs) are a group of rare tumors that account for 2% of all pancreatic malignancies, even though their incidence has been increasing over the past 20 years. Most PNETs are sporadic and tend to affect older individuals. Differently from functional tumors, which present with symptoms resulting from the specific hormone being elaborated, non-functioning pancreatic neuroendocrine tumors (NF-PNETs) typically present with symptoms related to local mass effect or metastatic disease. Today, due to the increasing use of abdominal imaging, NFPNETs are frequently discovered incidentally.

Case Report: A 32-year-old woman was admitted to our emergency department for worsening upper abdominal pain radiating to the back. Shortly after the admission, shock and peritoneal signs developed. An abdominal computerized tomography scan showed a solid mass (9 x 12 cm) of the pancreatic tail with severe hemoperitomeum. Exploratory laparotomy and subsequent distal splenopancreasectomy were performed for a bleeding tumor. Histopathological report showed a neuroendocrine, well differentiated tumor (G1). The postoperative course was uneventful and the patient was successfully discharged on 10th postoperative day.

Conclusion: Spontaneous rupture of solid neuroendocrine neoplasms of the pancreas can cause acute abdomen with potentially devastating effects.

Key Words: Abdominal pain, acute abdomen, Hemorrhagic shock, Pancreatic neuroendocrine tumor.