Pancreatic neuroendocrine tumor manifesting as upper gastrointestinal bleeding: a case report

Introduction: Majority of pancreatic neuroendocrine tumors present with abomdinal pain and weight loss, and very few present with gastrointestinal bleeding as their initial symptom.

Presentation of Case: A 51-year old male presented with a 7-month history of recurrent melena with a hemoglobin of 6.8 g/dL. On CT scan, the mass was heterogeneously enhancing, lobulated, and closely related to the medial wall of the descending duodenum. Gastroscopy showed a large polypoid, friable mass below the ampulla at the distal descending portion of the duodenum. Biopsy showed ulcerating neuroendocrine tumor. The patient was advised to undergo Whipple’s procedure.

Discussion and Conclusion: Pancreatic neuroendocrine tumors represent (pNET) 3% of primary pancreatic neoplasms and present with non-specific symptoms. Most patients present with abdominal pain or jaundice. Cases of gastrointestinal bleeding that have been reported were caused by invasion of bowel wall or development of esophageal varices. Surgical resection is the primary treatment of pNET.