Clinical presentations of small bowel tumor

Introduction: Small bowel tumors are amongst the uncommon in the gastrointestinal tract. The accumulation of data regarding their clinical presentation, etc. has been difficult. Most of the symptomatic lesions and tumors detected during surgery are malignant. Aim: To observe the clinical presentations of the small bowel tumors. Materials and methods: This was a prospective study of 17 cases of small bowel tumors done in Osmania General Hospital between 1994 and 1997, included both benign and malignant tumors and both primary and secondary tumors as well. Results: These tumors were seen between 30-80 years of age. Male to female ratio of the benign and malignant small bowel tumors was1.8: 1 and 1.75:1 respectively. 65% were Incidental findings. Anemia was seen in 58.8%. 83% of benign and 90% of malignant tumors presented with pain. 47.1% of the cases were diagnosed pre-operatively and 41.2% of the cases during emergency surgery. Benign tumors constituted 35.3% and the rest were malignant. 83.3% of the benign lesions were in the jejunum and 16.6% in the duodenum. Amongst, the malignant lesions, 54.60% of them were in the duodenum, 36.3% were in the jejunum and 9% were in the lleum. Conclusion: 65% of the small bowel tumors were found incidentally. Pain, obstruction, bleeding, palpable mass were the other modes of presentation, while anorexia and weight loss were noted in only the malignant ones. High index of suspicion is required to prevent delays.

Tumores neuroendócrinos do intestino delgado: experiência do Instituto Nacional de Câncer em 12 anos / Neuroendocrine tumors of the small intestine: experience of the National Cancer Institute in 12 years

Introdução: os tumores neuroendócrinos do jejuno e íleo representam 23-28% de todos os tumores endócrinos gastrointestinais. A taxa de incidência varia de 0,28 a 0,8 por 100.000 habitantes. Objetivos: revisar o tema e a experiência do INCA, culminando com definição de rotina de serviço. Material e Métodos: procedemos ao estudo retrospectivo dos casos de tumores neuroendócrinos de intestino delgado tratados no Serviço de Cirurgia Abdomino-pélvica do Instituto Nacional de Câncer (INCA) no período de 1996 a 2008, além de revisão bibliográfica. Resultados: relatamos os dados dos 7 casos tratados. Conclusão: concluímos serem os fluxogramas da ENETS (European Neuroendrocrine Tumor Society) válidos e expomos o fluxograma de conduta para estes tumores adotados no INCA.

Introduction: neuroendocrine tumors of the jejunum and ileum account for 23-28% of all gastrointestinal endocrine tumors. The incidence rate varies from 0.28 to 0.8 per 100,000 inhabitants. Objective: to review the theme and the experience of INCA cumino with definition of a routine service. Methods: we conducted the retrospective study of cases of neuroendocrine tumors of the small intestine treated at the Department of Surgery abdomino-pelvic National Cancer Institute (INCA) in the period 1996 to 2008, plus bibliographic review. Results: report the data of 7 cases treated. Conclusion: they are the flowcharts of ENETS valid and expose the flowchart of conduct adopted for these tumors in the INCA.

Experiencia clínica del uso de la videocápsula endoscópica en el diagnóstico de patología del intestino delgado / Clinical experience of using the video capsule endoscopy (VCE) as a diagnostic method in small intestine pathology

La videocápsula endoscópica (VCE), se introdujo en Colombia en junio de 2003 como método diagnóstico de las enfermedades del intestino delgado; realizamos un estudio observacional, retrospectivo, descriptivo, con 100 pacientes referidos para la práctica de VCE. Objetivos. Presentar la experiencia clínica de la utilización de la VCE en nuestra población, determinar las indicaciones más frecuentes para el estudio del intestino delgado con VCE en nuestro país, definir las patologías encontradas en el grupo de pacientes estudiados, describir los hallazgos de videocápsula en relación a los síntomas de los pacientes. Metodología. Se realizó un análisis descriptivo de las variables identificadas y estudiadas, se analizó el comportamiento de los datos, se calcularon las medidas de tendencia central y de dispersión de las variables en mención. Resultados. En el 97% de los exámenes la indicación fue el estudio del sangrado digestivo oscuro oculto o manifiesto, la patología diagnosticada con mayor frecuencia fue la patología vascular (angiectasias) del intestino delgado, seguida por las patologías inflamatoria (úlceras), parasitaria y tumoral. Conclusiones. El examen de VCE es de gran ayuda en el estudio del sangrado digestivo oscuro ya sea oculto o manifiesto y debe considerarse en nuestro medio de primera elección luego de la realización de endoscopia digestiva alta con visualización de la segunda porción duodenal (2) y de colonoscopia con ileoscopia (2), si el paciente no presenta síntomas obstructivos.

The VCE was introduced in Colombia in June 2003 as a method to diagnose diseases in the small intestine. We ran comprehensive observations with a series of 100 cases and created a retrospective and descriptive study of patients referred to us for the practice of VCE. Objectives. To present the clinical experience in the use of the VCE in our population. To determine the most frequent findings for the study of the small intestine with VCE in our country. To define the pathologies found in the group of patients studied, describe the video capsule findings in relation to the symptoms. Methodology. We conducted a descriptive analysis of the identified and studied variables, looking at the behaviour of the data the central trend and dispersion of the variables was calculated. Results. In 97% of the cases, the indication was for the study of occult or overt obscure digestive bleeding. The most frequent diagnosed pathology was the vascular pathology (angiectasias) of the small intestine; followed by the inflammatory pathology (ulcers) with tumours and parasite. Conclusion. The video capsule endoscopy exam is of great help in the study of obscure digestive bleeding whether it is occult or overt. It should be considered in our country as the primary choice after the upper digestive endoscopy with visualisation of the second duodenal portion (2) and the colonoscopy with ileoscopy (2) if the patient doesn’t present obstructive symptoms.

Clinical Review of Primary Small Bowel Tumors

PURPOSE: The aims of this study were to identify the clinicopathological features and treatment outcome of primary small bowel tumors. METHODS: Sixty-five patients, with primary small bowel tumors, treated at the Samsung Medical Center, between November 1994 and February 2002, were retrospectively analyzed. The mean follow-up was 20.8 months, ranging from 2 to 93 months. RESULTS: The mean age of the patients was 55.5 years, ranging from 26 to 84 years, with 42 men and 23 women. The most common symptom was abdominal pain (58.5%), followed by bleeding and an abdominal mass. The mean duration of the symptoms was 4.6 months, ranging from 2 days to 24 months. Diagnostic studies were performed by an abdominal CT scan, small bowel series, enteroclysis and angiography. The primary sites of the tumors were the jejunum and the ileum in 33 and 32 patients, respectively. Thirteen (20.0%) patients had benign tumors, including 8 (12.3%) benign stromal tumors, 2 lipomas, 2 hamartomatous polyps and 1 cavernous hemangioma. Fifty-two (80.0%) of the patients had malignant tumors, including 26 (40.0%) malignant stromal tumors, 21 (32.3%) lymphomas and 5 (7.7%) adenocarcinomas. Surgery was performed on all patients; a resection and anastomosis in 45 (69.2%), a right hemicolectomy in 10 (15.3%), an ileocecectomy in 5 (7.6%) and a wedge resection in a further 5 (7.6%). Metastasis was found on initial presentation in 21 (40.4%) patients. Combined liver, bladder and colon resections were performed in 7 (10.7%) patients. Four (6.1%) patients died during the perioperative period. The overall 3 year survival rate of the patients with malignant small bowel tumors was 58.6%. CONCLUSION: Performing aggressive surgical manipulation in suspected small bowel tumors, and the use of postoperative adjuvant therapy in lymphomas, will result in better outcomes for patients.