TITLE:
Primary cancers of the small bowel: About 20 cases
AUTHORS:
Noomen Haoues, Manel Mabrouk, Haithem Zaafouri, Rabii Noomene, Ahmed Bouhafa, Anis Ben Maamer, Abderraouf Cherif
KEYWORDS:
Primary Cancers; Small Bowel; Epidemiology; Diagnosis
JOURNAL NAME:
Open Journal of Gastroenterology,
Vol.4 No.2,
February
25,
2014
ABSTRACT:
Background: Cancers of the small bowel are rare. Diagnosis
is late and difficult because of the lack of specific signs. Treatment is surgical.
Prognosis is usually poor and depends on the histological type of tumor. Aim of
Study: To specify the epidemiological, clinical and therapeutic characteristics
of small bowel primary cancers in order to improve their prognosis. Material and Methods: This is a retrospective study
about 20 cases of malignant tumors of the small bowel, collected in the
department of general surgery of Habib Thameur Hospital in Tunis (Tunisia), from
January 1994 through June 2011. Results: Our series involved 11 women and 9 men
aged 62 on average (range: 44 - 80 years). In 45% of cases, the diagnosis was made
in a patient rushed to hospital with clinical features of acute generalized peritonitis (66% of all surgical
emergencies). Intestinal transit was performed in 5 patients only. Ultrasound abdominal examination was
performed in 11 patients. Abdominal CT scan was performed in 7 patients,
but the results were conclusive in 4 cases only (57%). Small bowel scanning was
done in 5 patients only, but led to a positive diagnosis in all of them. All of
our patients underwent surgery. Tumors of the small bowel were histologically
divided as follows: carcinoid tumor (8 cases), leiomyosarcoma (7 cases), giant B-cell
lymphoma (2 cases), malignant stromal tumor (2 cases) and malignant myxoid schwannoma (1 case). Malignant tumors of the small bowel most commonly arise in
the ileum (60%) followed by the jejunum (35%). As for the long-term course, there
was a recurrence at one year of a leiomyosarcoma and two recurrences of stromal
tumors associated with liver metastases. Conclusion: Small bowel cancers are rare.
Time to consultation is long and diagnosis is difficult and late due to the absence
of typical presentation. Treatment is surgical and progression depends essentially
on histological findings.