Primary Neoplasms of the Small Bowel

ABSTRACT

BACKGROUND: Primary tumor of the small bowel is uncommon less than 6% of all gastrointestinal tumors. Its symptoms and signs are nonspecific and its diagnosis is difficult. METHODS: We analyzed 43 patients with primary small bowel tumor who had undergone operations at the Chungnam National University Hospital from January 1990 to December 1997. RESULTS: 1) In total 43 cases, 19 cases (44.2%) were male and 24 cases (55.8%) were female, benign tumors were 13 cases (30.2%) and malignant tumors were 30 cases (69.8%). The mean age was 51 year. 2) The primary sites of benign tumors were the duodenum in 5, jejunum in 3, ileum in 5 cases. The primary sites of malignant tumors were the duodenum in 13, jejunum in 9, ileum in 8 cases. 3) Polyp was most common benign tumor (30.7%), and leiomyosarcoma was most common malignant tumor (43.3%). 4) The most common symptom was abdominal pain (65.1%), followed by melena (34.9%) and weight loss (20.9%). The most common sign was palpable mass (39.5%) and anemia (39.5%). 5) In the duodenal tumors, the detectabilities of endoscopy and upper gastrointestinal series were 68.8% and 71.4%, respectively. In the jejunal and the ileal tumors, the detectabilities of small bowel series were 62.5% and 71.4%, respectively and those of abdominal computed tomogram were 50.0% and 42.9%, respectively. The accuracy of preoperative diagnosis was 7 cases (53.8%) in benign and 20 cases (66.7%) in malignant tumor. 6) In cases of malignant tumor, curative resection was performed in 18 cases (60.0%), palliative resection was performed in 10 cases (33.3%), and bypass procedure was performed in 2 cases (6.7%). In cases of benign tumor, small bowel resection was performed in 9 cases and excision of duodenal polyp was performed in 2 cases. 7) The mean follow-up period of malignant tumor of 27 cases except 3 hospital mortality cases was 35 months. During this time, 7 cases were dead due to recurrence. The mean survival time of 7 mortality cases was 20.4 months, of them 4 cases were leiomyosarcoma, 2 cases were adenocarcinoma, and 1 case was lymphoma. CONCLUSIONS: Because diagnosis of small bowel tumor is difficult and confirmed in late stage, high degree of suspicion and endeaver to discover it is important.