Abstract
Neuroendocrine tumors (NETs) are notably rare and frequently arise from the gastrointestinal tract. Generally asymptomatic, NETs uncommonly result in acute abdominal pain. We present a case of known metastatic NET manifesting as acute-on-chronic mesenteric ischemia due to the involvement of the superior mesenteric artery (SMA) and vein (SMV). A 63-year-old female with metastatic NET presented with acute-onset abdominal pain. The patient was hemodynamically stable but uncomfortable appearing with significant pain. Imaging demonstrated decreased enhancement of several small bowel loops within the right lower quadrant concerning for bowel ischemia with a mesenteric mass encasing the SMA and SMV. Surgical intervention revealed a nonviable loop of small bowel. Second-look laparotomy was performed with viable remaining bowel, and an ileocolic anastomosis was successfully created. Acute-onset abdominal pain in a patient with NET warrants urgent. Mesenteric ischemia, while rare, should not be overlooked, as timely diagnosis and intervention are imperative.