Nutritional management of a patient with a small bowel neuroendocrine tumour and obstruction: a South African case study

Abstract

Small bowel neuroendocrine tumours (SBNETs) arise from enterochromaffin cells, most commonly in the terminal ileum. Functional tumours may secrete hormones, which can lead to carcinoid syndrome, whereas non-functional tumours often present later with symptoms of mechanical obstruction. Malnutrition is common in patients with gastroenteropancreatic neuroendocrine tumours (GEP-NETs) which includes SBNETs, and is worsened by tumour burden, medical therapies, hormonal activity, surgery, and postoperative catabolism.
A 55-year-old male presented with abdominal disomfort, early satiety, vomiting, and unintentional weight loss. Imaging revealed a small bowel mass with biochemistry tests indicating a neuroendocrine tumour (NET).  Preoperative nutritional assessment revealed severe malnutrition, prompting the initiation of parenteral nutrition prior to abdominal surgery. Throughout the preoperative and postoperative period, targeted nutritional intervention contributed to improvements in fluid balance, maintenance of skeletal muscle, and an increased phase angle, all reflecting an overall improvement in the patient’s nutritional status. Malnutrition in patients with NETs is multifactorial, and early identification, targeted nutritional support, and structured followup are essential to optimise recovery and long-term outcomes in this population.

Keywords: bioelectrical impedance, body composition, bowel obstruction, dietetics, hepatobiliary, neuroendocrine tumour, nutrition support, oncology, phase angle, surgery