S3535 A Unique Case of HER2 Positive Adenocarcinoma of the Small Bowel

Abstract

Syndrome in view of persistent symptoms. Her gastrin level came back elevated at 4,180 pg/ml after her medications were stopped to get the correct lab readings. A nuclear scan was scheduled for the patient to localize the gastrinoma lesion, but suddenly the patient became altered, hypotensive, and developed an acute abdomen. On further investigation with CT scan of the abdomen, patient was found to have pneumoperitoneum, secondary to bowel perforation. She underwent an emergent exploratory laparotomy, was found to have large perforations of the 3rd, 4th portion of the duodenum and several small perforations throughout the small bowel. A Para duodenal lymph node was taken and sent for pathology. Pathology revealed a well-differentiated neuroendocrine tumor: histological subtype gastrinoma. The patient underwent duodenal resection, gastrojejunostomy, cholecystectomy and feeding tube placement. Post-op period was complicated by patient having persistent dysphagia, initially to solids and progressed to have dysphagia to liquids as well. The patient underwent an EGD again which showed presence of esophageal stricture and had to undergo dilatation 6 times in a span of 2 months for symptom relief. She follows up with oncology and gastroenterology regularly and is scheduled to get a PET scan soon to rule out metastasis. (Figure ) Discussion: Gastrinomas manifest with peptic ulcer disease symptoms but some patients present with diarrhea. Serum gastrin levels of . 1000 pg/ml with symptoms is diagnostic of gastrinoma. A secretin provocative test is used for diagnosis if gastrin levels are , 1000 pg/ml. As clinicians, we must be aware of the complications of gastrinoma.