The Small Bowel Tumor Problem An Assessment Based on a 20 year Experience with 116 Cases

Abstract

Documented rarity, diagnostic difficulty and poor results stimulated this study of 79 malignant and 37 benign small bowel tumors in order to emphasize these lesions, determine their symptomatology and improve diagnosis and results, particularly in the malignant group. Chief symptoms were recurrent abdominal pain and tenderness, signs of obstruction and gastrointestinal bleeding. Fourteen cases were asymptomatic. The mean symptom-diagnosis interval was 6.6 months. Roentgenographic contrast studies were helpful in diagnosing 33 of 43 patients, with false negatives in 10. Laboratory studies were usually not helpful. Metastases were present at the time of surgery in approximately 58%. In the malignant group curative procedures were performed in 36 and palliative in 43, with an operative mortality of 10%. Five and 10 year survival rates were respectively 21/51 (41.2%) and 8/38 (21.2%) for malignancies. Individual 5 and 10 year survival rates were respectively as follows: carcinoid 11/15, 4/8; undifferentiated carcinoma 3/5, 1/3; lymphoma 3/11, 1/9; leiomyosarcoma 2/7, 1/6 and adenocarcinoma 2/13, 1/12. In the benign group results were excellent, except for one death from pulmonary embolism. The study suggests that if results with malignant small bowel tumors are to be improved, prompt diagnostic study and early consideration of laparotomy in patients with suggestive symptoms is mandatory.

Malignancy risk prediction for primary jejunum-ileal tumors

“…In accordance to other authors, abdominal pain, weight loss, anemia and nausea/vomit represented the signals and symptoms more commonly observed in our patients with malign tumors (9,10,11) . Among these patients, 51.9% had palpable abdominal mass.…”

“…Malign tumors often produce more exuberant clinical manifestations than benign tumors. However, because of the unspecific signals and symptoms observed, the mean time required for diagnosis was close to 6 months, a fact that is corroborated by the literature (8,9) . Lesions that lead to digestive hemorrhage occur more frequently in the proximal small bowel segment, what is likely to be explained by the larger diameter of jejunum, allowing for tumoral growth with posterior ulceration and hemorrhage.…”

“…Primary jejunum-ileal tumors are among the rarest tumors in the digestive tube, but they should always be in mind, mainly for those patients older than 40 years with unexplained recurrent abdominal pain, obstructive intestinal symptoms, as well as anemia and gastrointestinal hemorrhage (9) . Only when we make an early diagnosis we are able to provide a better prognosis to these patients.…”

"Segmental Resection of Duodenal Adenocarcinoma: Case Report"

“…Partial resection of the duodenum is a warranted alternative to a duodenopancreatectomy, as this procedure has a lower operative morbidity, while providing comparable oncological results [9][10][11][12].…”

Neuroendocrine Tumour of the Ileum Presenting As Intestinal Obstruction in a 23 yr Old Female: A Case Report and Literature Review

“…1 These are most commonly diagnosed after the 5th decade of life with peak occurrence in the 6th and 7th decades. 2 Neuroendocrine tumors (NET) are neoplasms of enterochromaffin cells which display neurosesretory capacity and may result in the carcinoid syndrome. 3 These tumors are uncommon but the most common primary tumors of the distal small intestine.…”