Vol 41 # 3 September 2009 - Kma.org.kw

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KUWAIT MEDICAL JOURNAL September 2009
Original Article
Small Bowel Tumors: Insidious and Important
Abdominal Problems for Surgeons
Mehmet Yildirim 1 , Savas Yakan 1 , Ozgur Oztekin 2 , Emrah Bayam 1 , Hakan Postaci 3 , Mehmet Haciyanli 4
1
Department of Surgery, Izmir Bozyaka Teaching and Research Hospital, Izmir, Turkey
2
Department of Radiology, Izmir Bozyaka Teaching and Research Hospital, Izmir, Turkey
3
Department of Pathology, Izmir Bozyaka Teaching and Research Hospital, Izmir, Turkey
4
Department of Surgery, Izmir Ataturk Teaching and Research Hospital, Izmir, Turkey
ABSTRACT
Kuwait Medical Journal 2009; 41 (3): 230-235
Objectives: To evaluate the major clinical symptoms,
etiology and presentation of small bowel tumors so that
they can be diagnosed
Design: Retrospective study
Setting: Izmir Bozyaka Teaching and Research Hospital,
Turkey
Subjects and Methods: Forty-five patients with 46 small
bowel tumors over a 15-year period were included in the
study
Intervention: Biopsy or small bowel resection
Main Outcome Measures: The data obtained from the
medical records including clinical features, diagnostic
workup, operative procedures and pathologic diagnosis
Results: The male to female ratio was 1.4:1 with a median
age at presentation of 53 years (range, 30 – 83 years). Thirty
(66.7%) patients presented with abdominal emergencies
such as bowel obstruction (40%), bowel perforation (24.4%)
and intestinal bleeding (2.3%). Non-urgent presentations
were found in 15 (33.3%) patients. The preoperative
diagnosis of small bowel tumor was positive in nine (20%)
of the elective cases. The tumors were located in the ileum
in 68.8%, the jejunum in 26% and the duodenum in 6.6% of
patients. Thirty-eight (82.6%) malignant and eight (17.4%)
benign tumors were identified. In addition, patients with
malignant tumors more commonly presented with bowel
obstruction and perforation. Segmental resection was
done in 41(91%) patients.
Conclusion: These observations suggest that small bowel
tumors are difficult to diagnose because of delayed
presentations and vague symptoms. Clinicians must have
a high degree of suspicion and should perform early
laparotomy without hesitation.
KEY WORDS: benign, malignant, small bowel, tumor
INTRODUCTION
Although the small intestine constitutes one of
the largest surface areas in the human body, less than
3 - 6% of gastrointestinal malignancies occur in the
small bowel [1-4] . The tumors may be found (in order
of increasing frequency) throughout the duodenum,
jejunum, and ileum. Clinically, small bowel tumors
are characterized by a lack of identifying symptoms.
Abdominal pain is the most common clinical
symptom in patients with a tumor of the small
bowel [5,6] . On the other hand, bleeding is the most
common presenting complaint in patients with
benign tumors; obstruction and perforation were
found to be associated with malignant tumors [7] .
An appreciable number of small bowel tumors
apparently cause no serious symptoms during
a lifetime. Diagnosis is delayed or missed in
many clinical cases because symptoms may be
absent or vague and non-specific until significant
complications develop. Many small bowel tumors
are diagnosed during emergent surgery. Attention
to vague symptoms and an aggressive diagnostic
evaluation are important for diagnosis and
treatment.
MATERIAL AND METHODS
Medical records of 45 patients who were operated
on for small bowel tumors at the Department of
Surgery, Izmir Bozyaka Teaching and Research
Hospital, Turkey from January 1990 to January
2005 were reviewed. The data obtained from the
medical records included clinical features, diagnostic
workups, operative procedures and pathologic
diagnoses. All cases underwent surgery and were
confirmed by histopathology. Periampullary tumors
were excluded.
Address correspondence to:
Mehmet Yildirim , Atakent Mah, Bergama 2, Apt.Giris 32 Daire1, Bostanli / Izmir, Turkey. Tel: 00 90 2323625692, Fax: 00 90 232 2614444 ,
E-mail:mehmetyildi@gmail.com