Primary tumors of the small bowel: a clinicopathological study of 58 cases

Various reviews documenting the rarity, diagnostic problems, and poor survival statistics prompted this retrospective clinicopathological study of 58 cases of primary small bowel tumors, periampullary and mesenteric tumors excluded, over a 14-year period between 1966 and 1979 inclusive. Of these cases 36 were male and 22 were female, ranging in age from 13 to 65 years. Initially, the symptoms were vague and ill defined. Prominent clinical features were: intermittent abdominal pain (6+%), loss of weight (62%), abdominal lump (53%), and chronic bleeding (7%). Routine barium meal examination and laboratory investigations were not helpful in preoperative diagnosis. Of these tumors 28 were benign and 30 malignant, with the commonest benign and malignant tumors being leiomyoma and lymphoma, respectively. The commonest site of involvement was the ileum both for benign and malignant lesions. None of the benign tumors was found in the duodenum. All patients with benign tumors, discovered either at laparotomy for intestinal obstruction or during surgical procedures for other diseases, had excision of the tumor through enterotomy or resection of small bowel with end-to-end anastomosis. Of 30 patients with malignant tumors, 12 underwent resection of the growth and end-to-end anastomosis. Of the remaining 18 unresectable cases, 7 had by-pass procedures and 11 had only biopsy. All patients of benign tumors are well without any gastrointestinal symptoms. All the malignant cases, except three cases of adenocarcinoma and two of lymphoma who underwent resection, died within 5 years. The 5-year survival of only 8.6% in malignant tumors indicates the necessity of an early exploratory laparotomy in doubtful cases with vague abdominal symptoms. A bold interventionist approach should improve the otherwise dismal outlook of malignant small bowel tumors.