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

September 2009
KUWAIT MEDICAL JOURNAL 233
Fig. 4: Specimen of the ileum with narrowed lumen. Histopathologic
examination revealed adenocarcinoma of the ileum.
that patients are reluctant to go see a physician on
account of indefinite symptoms. On the other hand,
physicians may not recognize the importance of
mild symptoms as they relate to small bowel tumors.
Although, Rankin et al reviewed and analyzed the
characteristics of these tumors 70 years ago [8] , few
advances have been made since.
Thus, in this article, we hope to highlight the
seriousness and importance of small bowel tumors
and to attract the attention of individuals who may
interact with small bowel tumors.
Over 75 - 90 % of small bowel tumors occur in
patients between 45 and 60 years of age. In our study,
the mean age was 53 years, which is comparable to
that in other studies [9] . Our study reports the maleto-female
ratio to be 1.4:1. The male-to-female ratio
ranged from 1.4:1 to 3.1:1 in other series [9,10] .
In our study, the most common symptoms were
abdominal pain (100%), nausea-vomiting (73%)
and obstruction (40%). These symptoms have been
reported to occur in 8 - 80% of patients [11-13] . While in
one series [14] , intestinal obstruction, hemorrhage and
pain were found to be the most common symptoms,
we discovered similar findings in four previous
studies [11-13,15] .
Other investigators have analyzed the correlation
between the symptoms associated with and the
types of the tumors [16] . While they have suggested
that malignant tumors, typically scirrhous and
prone to result in a narrowing of the lumen, are
associated with a higher proportion of symptoms,
signs and episodes of obstruction [3] , benign tumors
are generally characterized by slow growth and a
delayed clinical presentation. In one study, tumor
size was reported to be associated with abdominal
complaints while it was not found to be a factor
according to another series (regardless of tumor
type or tumor location) [17] .
The malignant-to-benign tumor ratio is most
commonly reported to be 4:1. In our series, the ratio
Fig. 5: Macroscopic view of the ileum with gastrointestinal
stomal tumor (GIST)
was 4.7:1. Others showed an equal frequency of
benign and malignant lesions [1,3,18] .
In our study, obstruction and perforation were
found to be the most common, while bleeding
was only observed infrequently (40%, 24.4%, and
2.2%) [9,10,19] . Intestinal obstruction (34%) was more
commonly associated with malignant tumors,
while gastrointestinal bleeding occurred in 32% of
patients [3] . In one series, perforation through small
bowel malignant tumors was found in 5.1 - 30% of
the cases [11] .
In 1979, in a series of small bowel tumors, 50% of
the tumors were reported to be present in the ileum,
41% in the jejunum, and 15% in duodenum [10] . In a
final retrospective study, the most prevalent tumor
sites were found, interestingly, to be the ileum
(29%), duodenum (25%) and jejunum (15%) [20] . In
our series, tumors were found to occur 68.8% in
the ileum, 26.1% in the jejunum and rarely, 3.3%
in the duodenum. However tumors may be found
(in order of increasing frequency) throughout the
duodenum, jejunum and ileum [1,18,21] .
Histologically, adenocarcinoma was found to
be the most common type of malignant tumor in
multiple series [22] . The remaining tumors were
NETs, gastrointestinal stomal tumors (GISTs)
and lymphomas [3,4,23] . In our group, 28.3% of the
cases were reported to be (in order of decreasing
frequency) adenocarcinoma, lymphoma, GISTs
and NETs. In a clinical study, the most prevalent
histologic type was identified as NET(33%),
followed by adenocarcinoma and lymphoma [20] .
On average, adenocarcinomas are distributed
most frequently in the duodenum followed by
the jejunum and ileum, whereas lymphomas are
more common in the jejunum and the ileum. In
our study, adenocarcinomas and lymphomas
were mostly located in the ileum. Interestingly,
lymph node metastases have been reported in
approximately half of the patients at the time