Laparoscopic Diagnosis and Treatment of Small Bowel Tumors in 24 Patients / 中国微创外科杂志

Objective To evaluate the clinical value of laparoscopy in the diagnosis and surgical treatment of small intestinal tumors. Methods After the establishment of pneumoperitoneum with umbilicus puncture, a laparoscope was inserted.Two 5-mm trocars were placed through lateral right and left rectus abdominis to explore the location of the small intestine tumors.A 3 -4 cm incision was made along the abdominal midline or lower abdomen median.With the use of incision protector,benign tumors were given local excision of small intestine,or malignant tumors were given radical resection.End to end or side to side anastomosis of bowel was carried out,and then the mesenteric hole was closed and the puncture hole sutured. Results All the patients were diagnosed and treated by laparoscopic procedure successfully, including 23 cases of laparoscopic-assisted partial intestinal resections and 1 case of right hemicolectomy.The mean operative time was(70.3 ±21.7)min,the mean blood loss was(18.5 ±3.1)ml,the mean length of incision was(3.5 ±1.1)cm, and the mean time for passage of flatus was(2.5 ±0.5)d.Postoperative pathological examinations showed benign tumors in 8 cases,most of which were leiomyoma(5 cases), and malignant tumors in 16 cases, most of which were stromal tumors(6 cases).The postoperative hospital stay was(6.5 ±2.5)d.Follow-ups were conducted for 0.5-4.5 years(mean, 2.6 years)in 19 cases,including 6 cases of benign tumor and 13 cases of malignant tumor.No recurrent tumor was found except one fatal case of advanced intestinal carcinoma. Conclusion Laparoscopic exploration can diagnose small intestinal tumors accurately, and laparoscopic-assisted surgical treatment is safe.

Laparoscopic Diagnosis and Treatment of Small Bowel Tumors in 24 Patients / 中国微创外科杂志

Objective To evaluate the clinical value of laparoscopy in the diagnosis and surgical treatment of small intestinal tumors. Methods After the establishment of pneumoperitoneum with umbilicus puncture, a laparoscope was inserted.Two 5-mm trocars were placed through lateral right and left rectus abdominis to explore the location of the small intestine tumors.A 3 -4 cm incision was made along the abdominal midline or lower abdomen median.With the use of incision protector,benign tumors were given local excision of small intestine,or malignant tumors were given radical resection.End to end or side to side anastomosis of bowel was carried out,and then the mesenteric hole was closed and the puncture hole sutured. Results All the patients were diagnosed and treated by laparoscopic procedure successfully, including 23 cases of laparoscopic-assisted partial intestinal resections and 1 case of right hemicolectomy.The mean operative time was(70.3 ±21.7)min,the mean blood loss was(18.5 ±3.1)ml,the mean length of incision was(3.5 ±1.1)cm, and the mean time for passage of flatus was(2.5 ±0.5)d.Postoperative pathological examinations showed benign tumors in 8 cases,most of which were leiomyoma(5 cases), and malignant tumors in 16 cases, most of which were stromal tumors(6 cases).The postoperative hospital stay was(6.5 ±2.5)d.Follow-ups were conducted for 0.5-4.5 years(mean, 2.6 years)in 19 cases,including 6 cases of benign tumor and 13 cases of malignant tumor.No recurrent tumor was found except one fatal case of advanced intestinal carcinoma. Conclusion Laparoscopic exploration can diagnose small intestinal tumors accurately, and laparoscopic-assisted surgical treatment is safe.

Diagnosis and treatment of primany small intestinal tumor:a report of 40 cases / 中国医师进修杂志

Objective To explore the clinical characteristics,misdiagnosis reason,diagnosis and treatment of primany small intestinal tumor.Methoed Retrospective analysis of the clinical data were made on 40 cases of primary small intestinal tumors.Results Before operation,13 cases were given confirmed diagnosis of small intestinal tumor.The rate of misdiagnosis was 67.5％ (27/40).Partial excision were administered in 10 cases with benign small intestinal tumor.Adical excaision were performed in 24 cases with malignant tumors,palliative excision in 3 cases and shortcut operation in 3 cases.One patient died after opreation.Conclusions Before operation,the misdiagnostic rate of primary small intestinal tumor is high.Fiber endoscopy and X-ray may bring a high diagnostic rate of small intestinal tumor.

Hemangioma cavernoso: una causa de hemorragia digestiva de origen oscuro / Cavernous hemangioma: a source of bleeding of obscure origin

Comunicamos el caso de un paciente de 32 años, sexo masculino, que consultó por melena intermitente y síndrome anémico de dos años de evolución, sin otros antecedentes patológicos de importancia. El laboratorio reveló anemia hipocroma, sin trastornos de la coagulación. Los exámenes endoscópicos altos y bajos del tubo digestivo no demostraron lesiones sangrantes y la cintigrafía evidenció un sangrado a nivel de intestino delgado. La arteriografía mesentérica selectiva demostró un hemangioma en porción terminal del íleon. Se realizóresección del segmento intestinal comprometido, evolucionando favorablemente, sin reincidencia de sangrado hasta la fecha. Efectuamos una revisión de la literatura principalmente dedicada a la incidencia de esta patología y al enfoque de pacientes que se presentan con un sangrado digestivo de origen oscuro.

A 32 years old man presenting with two years of intermittent episodes of melena and anemia, without other pathological conditions. The laboratory results showed an hypochronic anemia. Coagulation studies were normal. No bleeding lesions were observed at upper and lower endoscopy. A scintigraphic study showed evidences of bleeding at the small bowel. Mesenteric angiography reported an ileal hemangioma. A resection of the lesion was performed without further bleeding until now. A review of the subject was done, looking for the incidence and behavior, in relation of the case, and patients with intestinal bleeding of obscure origin.

Analysis of clinical misdiagnosis on primary small intestinal tumor / 中国基层医药

Objective To explore the clinical characteristics and causes of misdiagnosis of primary small intestinal tumors.Methods 54 cases of primary small intestinal tumors were retrospectively analyzed.Results Among them,32 of 54 cases were misdiagnosed for 2 to 16 months.Preoperative misdiagnosis rate was 59%.In this group,11 cases were benign tumors while the other 21 cases were malignant tumors located at duodenum jejunum and ileum were found in 7 cases,13 cases and 12 cases respectively.The most common clinical presentations were abdominal pain,abdomen mass,gastrointestinal haemorrhage and jaundice,etc.The accurate diagnosis rate of whole digestive tract radiography and CT scanning was lower,while small radiography of hypotonic and CTVE and MRVE and DSA was helpful to make sure the portion and quality of the lesion.Conclusion The reasons of misdiagnosis are following:insufficient understanding about the disease,the clinical presentation of primary small intestinal tumor is untypical prognosis of these patients.

A Case of Bleeding Jejunal Leiomyoma Preoperatively Diagnosed by Enteroscopy / 대한소화기내시경학회지

Lower GI bleeding occurs less frquently than upper GI bleeding. Most of the lower GI bleeding is from the colon, with 15-20% of all episodes involving the small intestine. These episodes stop spontaneously in 80% of all cases, but bleeding is recurrent in 25% of these patients. The most common cause of small intestinal bleeding is angiodysplasia, and the next is benign tumors. More than 50% of benign lesions of the small intestine remain asymptomatic and are discovered during an autopsy. Diagnosis of small intestinal lesions is not easy because of nonspecific symptoms and anatomical specificity. For instance, a 47-year-old woman was admitted to us with a 2-day history of melena. A small bowel enema revealed a filling defect at the level of 20 cm below the ligament of the Treiz. An enteroscopy revealed an ovoid elevated lesion with a central black spot and an ulceration in the proximal jejunum. An enteroscopic biopsy revealed leiomyoma. A jejunal mass was excised through a segmental resection. Pathological diagnosis of the resected mass revealed the same leiomyoma.

A Clinical Study on Eighteen Cases of Primary Small Intestinal Tumor / 昆明医科大学学报

The investigation confirms that 44.4% preoperative diagnosis was gained on 18 cases of primary small intestinal tumor, especially, a better understanding about the significances in using modern detective methods, such as B-ultrasonography, CT and X-ray, etc. in the diagnosis of small intestinal tumor was achieved. The clinical and pathological characteristics of primary small intestinal tumor were studied and the therapies were further discussed in de- tail based on modern surgery theories and techniques.