Primary jejunoileal neoplasmas: a review of 60 cases

Primary neoplasmas of the jejunum and ileum are infrequent and lack specific manifestations and inaccessibility of conventional endoscopy, so the diagnosis of these tumors are usually delayed. So far the data of primary jejunoileal neoplasmas is still scarce, especially in Chinese medical literature in English. There may be some differences among the Chinese and the westerners in jejunoileal neoplasmas.

A retrospective analysis was made on clinical findings and pathological types.

Of the 60 patients with jejunal or ileal neoplasmas, the most frequent symptom was abdominal pain (57 %), followed by tarry stool (43 %) and hematochezia (10 %). Abdominal mass (40 %) was the most common finding on physical examination, followed by anemia and weight loss (35 %). 67 % of the jejunoileal neoplasms were located in the jejunum. Among the malignant neoplasmas (68 %), malignant stroma (47 %) was most common, while the benign stromoma (20 %) was the most common benign neoplasmas. Preoperatively, 40 patients (67 %) were diagnosed as small bowel neoplasmas, of which 34 were found by enteroclysis. Abdominal mass was shown by CT in 18 cases and by ultrasonography in 13. The mean duration of symptoms before diagnosis was 7 months. In 41 patients with malignant tumors, the duration of symptoms before diagnosis exceeded 12 months in 21 cases, lymphatic or distant metastases were found in 26 (63 %)cases during operation. An emergency laparotomy was performed in 4 patients (7 %) owing to intestinal obstruction or perforation.

Primary jejunoileal neoplasmas in Chinese present some difference from Westerners on clinical features and histopathologic types. Enteroclysis remains the major relevant diagnostic procedure in this study, the misdiagnotic rate is high preoperatively due to failure of detection by conventional imaging procedures such as CT and inaccessibility of routine endoscopy. For the suspected patients, combined application of aforementioned procedures may facilitate early diagnosis. The wireless capsule endoscopy may improve the diagnostic rate of jejunoileal neoplasmas in the future.