Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:21

1358 Small Bowel Tumors

Imaging

■Plain abdominal films: usually nondiagnostic; may demonstrate

obstruction, free subdiaphragmatic air

■Barium contrast studies (UGI with small bowel follow-through or

enteroclysis): best tests to locate and possibly define small bowel

lesions; enteroclysis has a reported sensitivity of 90% versus 33% for

conventional SBFT

■Computed tomography (CT): useful in identifying a tumor mass and

may define extraluminal or metastatic disease

■Upper endoscopy: direct visualization limited to duodenum; may

perform biopsy or polypectomy

■Push enteroscopy: extends endoscopic visualization to jejunum;

biopsy capability

differential diagnosis

■Symptoms of obstruction, bleeding or pain lead to broad diag-

nostic categories: common causes include ulcer disease, vascular

ectasias, bleeding vascular lesions, Meckel’s diverticulum, portal

hypertension, hemobilia, endometriosis, pneumatosis intestinalis,

adhesions, enteric duplication cysts, strictures, pancreatic rest, infla-

mmatory bowel disease, and other ulcerative diseases

management

What to Do First

■Assess the type of neoplasm (benign versus malignant, histology)

and evaluate extent of disease

General Measures

■History, physical, and appropriate tests to evaluate extent of disease

■Surgical consultation often necessary

specific therapy

■Some form of therapy indicated for all patients regardless of histology

or symptoms

Treatment Options

■Benign neoplasms: resection by endoscopy (biopsy or polypectomy)

or laparotomy; choice of therapy depends on size of lesion, growth

pattern, and location

■Malignant neoplasms:

■Adenocarcinoma – surgical treatment is indicated with wide seg-

mental resection; pancreaticoduodenectomy may be required for

tumors in the first or second portions of the duodenum; role of

chemotherapy or radiation therapy uncertain