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

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Small Bowel Tumors: Insidious and Important Abdominal Problems for Surgeons
September 2009
Fig. 1: Transverse CT scan showing the abdominal mass and
dilated intestinal loops
Fig. 2: CT showing a mass with hazy margins in the bowel wall
Fig. 3A and B: CT scan demonstrates a narrowed lumen of the distal ileum. At surgery, an adenocarcinoma of the ileum was found.
Treatment:
Thirty (66.7%) patients underwent emergency
operations and 15 (33.3%) received elective surgical
intervention. Segmental resection of the small
bowel with end to end anastomosis was carried
out in 41 (91%) out of the 45 patients. Among the
malignant and benign tumors, segmental resections
of the jejunum-ileum were performed in 40 (88.8%)
patients and a duodenum resection was performed
for one patient (Fig. 3A-B).
Four patients were deemed unresectable because
of locally advanced disease of the ileum. In these
cases, only biopsy was performed.
Anatomical distribution and characteristics of the
tumors:
Thirty-one (68.8%) of the 46 lesions arose in
the ileum, 12 (26.1%) arose in the jejunum and
three (6.6%) occured in the duodenum. Thirtyeight
(82.6%) malignant and eight (17.4%) benign
tumors were identified (malignant-to-benign ratio,
4.7:1). The anatomical distribution of the malignant
tumors was as follows: the tumor presented in the
ileum, jejunum and duodenum in 26 (57.7%), nine
(20%), and three (6.6%) patients, respectively (Fig. 4
and 5). Benign tumors were found more commonly
in the ileum and jejunum, with five and three
patients presenting with a tumor in each region,
respectively. In one case, a synchronous tumor,
adenocarcinoma, was found in the duodenum and
jejunum. The distribution of tumor locations in
patients, as obtained via a pathologic diagnosis, is
shown in Table 2. Lymph nodes were involved in
the diagnosis of the tumors in seven (15%) patients,
and the histological types of the observed tumors
were adenocarcinoma, neuroendocrine tumor
(NET), lymphoma and malignant melanoma in
three, two, one and one patients, respectively. The
histopathologic types of the unresectable tumors
were adenocarcinoma and NET. There were two
occurences of each type. Two patients had secondary
tumors from lung cancer presenting as small bowel
malignancies.
DISCUSSION
The clinical presentation of small bowel tumors
is frequently insidious and often overlooked by
physicians [2] . This delay is probably due to the fact