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

September 2009
KUWAIT MEDICAL JOURNAL 231
Table 1: Preoperative condition of patients with respect to the
biological nature of the tumor
Clinical Status Malignant Benign
n (%) n (%)
Symptoms
Abdominal pain 30 (66.6) 15 (33.3)
Nausea-vomiting 27 (60.0) 6 (13.3)
Hematochezia 1(2.2) -
Signs
Abdominal tenderness 12 (26.6) 6 (13.3)
Abdominal distension 19 (42.2) 4 (8.8)
Abdominal mass 4 (8.8) 1 (2.2)
Weakness 13 (28.8) 3 (6.6)
Non- urgent 12 (26.7) 3 (6.8)
Urgent ( Obstructive )
Simple obstruction 11(24.4) 2 (4.4)
Intussusception 3 (6.7) 2 (4.4)
Perforation 10 (22.2) 1 (2.2)
Bleeding 1 (2.2) -
The main objective of this retrospective study
was to assess the prevalence and clinical importance
of small bowel tumors in our medical practice. This
study was approved by the ethical committee.
RESULTS
Incidence and demographic features:
Forty-five patients, 38 with malignant and
eight with benign tumors of the small bowel were
operated on during this 15 year period. During the
same period 7,820 patients were operated on in our
Department of Surgery giving our clinic an incidence
of approximately 5 / 1,000 patients. Multiple tumors
were encountered in one patient.
The median age of the patients was 53 years
(range, 30 - 83 years) at the time of diagnosis. While
mean age at presentation was 63.5 years (range, 59 to
83) in patients with malignant tumors, it was found
to be 51.5 years (range, 30 to 62) with benign tumors.
There were 26 (57.7%) male and 19 (42.3%) female
patients in our series. The male-to-female ratio was
1.4:1.
Symptomatology:
The most frequent complaints were intermittent
abdominal pain and nausea-vomiting in 45 (100%)
and 33 (73.3%) patients, respectively. Weight loss
was found in 16 (35.5%) patients.
The majority of patients had no physical sign
of the disease. Abdominal distension, abdominal
tenderness and mass were the most common clinical
signs, and were found in 23 (51.1%), 18 (40%) and
nine (20%) patients, respectively.
Non-urgent presentations were found in 15
(33.3%) patients. Urgent presentations in the form
of intestinal obstruction were present in 18 (40%)
Table 2: Distribution of the tumor location according to pathologic
diagnosis
Pathologic diagnosis Duodenum Jejunum Ileum Total
n (%) n (%) n (%) n (%)
Malignant
Adenocarcinoma 1 (2.1) 3 (6.5) 9 (19.5) 13 (28.3)
Lymphoma - 3 (6.5) 6 (13.1) 9 (19.6)
Malignant GIST† 2 (4.2) - 5 (10.8) 7 (15.2)
Malignant NET‡ - 3 (6.4) 2 (4.2) 5 (10.8)
Malignant melanoma - - 2 (4.3) 2 (4.3)
Metastasis - - 2 (4.3) 2 (4.3)
Benign
Lipoma - - 2 (4.3) 2 (4.3)
Benign GIST - 1 (2.1) 1 (2.1) 2 (4.3)
Leiomyoma - 1 (2.1) 2 (4.3) 3 (6.5)
Mesenchymal tumor - 1 (2.1) - 1 (2.1)
Total 3 (6.5) 12 (26.1) 31 (67.4) 46 (100)
† Gastrointestinal stromal tumor, ‡ Neuroendocrine tumor
patients. They were due to simple obstruction in 13
and intussusception in five patients. Intraluminal
simple obstructions of the jejunum and ileum
were found in three and ten patients, respectively.
Intussusceptions were found in the jejunum and
ileum in one and four patients, respectively. The
initial presentation was acute perforation in 11
(24.4%) patients, seven of whom had an ileal
perforation and four of whom had jejunal perforation.
Gastrointestinal bleeding was present in one (2.2%)
patient with a duodenal tumor (Table 1). Two patients
had a history of another primary malignancy (lung
cancer). The secondary tumors turned out to be
metastases from lung cancer in these patients.
Diagnosis:
Preoperative diagnosis was made by enteroclysis,
gastro-duodenoscopy, ultrasonography (US)
and computed tomography (CT). Evidence of
an intestinal obstruction was demonstrated in
17 (37.7%) patients by plain abdominal X-ray.
Pneumoperitoneum was noted in eight (17%)
patients. Small bowel series (enteroclysis) were
used as diagnostic investigations in four (8.8%)
cases with suspected clinical findings. Enteroclysis
revealed small bowel abnormalities in all patients.
One case of the tumor of the duodenum was
detected by gastro-duodenoscopy.
Out of the 45 patients 29 (64%) underwent US
and abdominal masses were visualized in four
(8.8%) cases.
CT was performed on 15 (33.3%) patients, and it
was helpful in locating the abdominal masses in five
(11%) (Fig. 1 and 2). As a result, the preoperative
diagnosis of small bowel tumor was positive in nine
(20%) of the elective cases.