Small bowel tumours: a diagnostic challenge

In a 20-year retrospective study of 43 patients having surgery for small bowel neoplasia in a district general hospital, the commonest pathologies were lymphoma (12), carcinoid (12) and adenocarcinoma (11). Malignant neoplasms occurred in 38 patients presenting on average at 68 years of age. In 4 patients a synchronous gastrointestinal neoplasm was found. The average duration of symptoms was 11 weeks for operated patients. In 31 patients the presentation was as a surgical emergency. Only 10 had imaging investigations prior to emergency presentation from which diagnostic information was obtained in 1 patient and helpful information in a further 4. The 5-year survival figures of patients with small bowel neoplasia were carcinoid (50%), lymphoma (27%) and adenocarcinoma (15%), reflecting the poor prognosis of these patients even after 'curative resection'. Patients with carcinoid tumours were the exception, as long-term survival was not unusual even without complete resection of all macroscopic disease.