PICTURES IN DIGESTIVE PATHOLOGY 1130-0108/2015/107/11/697-698 REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS COPYRIGHT © 2015 ARÁN EDICIONES, S. L. REV ESP ENFERM DIG (Madrid) Vol. 107, N.º 11, pp. 697-698, 2015 Comb sign in intestinal obstruction secondary to desmoplastic reaction due to an ileal neuroendocrine tumor Marcello Di-Martino, Íñigo García-Sanz, José Luis Muñoz-de-Nova, Cristina Marín-Campos and Elena Martín-Pérez Hospital Universitario de La Princesa. Madrid, Spain CASE REPORT A 77-year-old man was seen in the emergency department with an intestinal obstruction in the absence of prior surgery or complicated hernias. Abdominal computed tomography (CT): Mesenteric nodule in distal ileum with hyperdense lineal images compatible with comb sign and proximal dilation of intestinal loops (Fig. 1 A and B). The patient underwent surgery based on the diagnosis of intestinal obstruction secondary to a mes- enteric tumor, possibly related to lymphatic ducts infiltration of ileal tumor not displayed on the TC. Surgical exploration: Distal ileum mesenteric node congruent with the image of CT and mass in the adjacent ileum (Fig. 1C). Oncologic resection of ileal segment was performed. Pathology report: 3 cm size ileal Fig. 1. A and B. Mesenteric calcified nodule 20x27 mm, with hyperdense lineal images and retraction of the affected mesentery compatible with comb sign. Dilation of proximal intestinal loops. No lesions in intestinal wall can be seen. C. Calcified metastatic mesenteric lymph node of distal ileum (black arrow) and tumor in the intestinal wall (white arrow). neuroendocrine tumor (NET) with mesenteric infiltration. Two of seven positive lymph nodes. Well differentiated, G1 (Ki-67: 1%). Immunohistochemical study: Positive for chromogranin A (CgA) and synaptophysin. Post-operative uneventful. The 111 In-oct- reotide postoperative scan showed no pathological deposits. The patient has had no new episodes of intestinal obstruction or evidence of recurrence at two years after surgery. DISCUSSION NETs of the gastrointestinal tract are rare tumors arising from enterochromaffin cells. They are usually small asymp- tomatic tumors, diagnosed incidentally on imaging studies, due to metastatic spread, or to clinical symptoms of hormonal