Small bowel malignancies: a review of 29 patients at a single centre

We analysed the incidence, clinical presentation and outcome of small bowel malignancies treated in the department.

From July 1993 to December 2001, 29 patients with small bowel malignancies were operated upon. The median age was 60 years (30-87 years), and there were 11 males and 18 females. The more frequently used diagnostic investigations included barium contrast studies, and CT scanning.

The most frequent complaint was abdominal pain, though other symptoms like abdominal mass, weight loss and change in bowel habit may also be present. Intestinal obstruction necessitated emergency operation in some cases. One case was treated as Crohn's stricture and two others, as irritable bowel syndrome for nearly 6 months before referral was made for surgery. Fifteen cases were secondaries to the small bowel, and fourteen were primary small bowel malignancies. The secondaries were metastases from colorectal cancers (8), gynaecological cancers (5), breast (1) and transitional cell carcinomas (1). Of the 14 primary small bowel malignancies, there were 8 lymphomas, 4 adenocarcinomas and 2 neuroendocrine tumours. Eleven of these patients were alive at mean follow-up of 25 months (1-97 months) and 2 were lost to follow-up. Only one of the secondary small bowel malignancies was alive at the time of review.

Small bowel malignancy is a rate entity with pre-operative diagnosis remaining difficult. Early surgical intervention with a high index of suspicion is required to improve survival.