Small bowel tumors

Detection of Neuroendocrine Tumours by Enteroscopy: A Case Report

We present the case of a 62-year-old patient who developed melenas and in whom conventional endoscopic tests could not detect any bleeding lesion. In our case, capsule endoscopy and enteroscopy were the pivotal elements in establishing the diagnosis of a neuroendocrine tumour with an atypical location. As a result, it was possible to surgically remove the lesions at an early stage of the malignancy without metastatic disease and without the need for adjuvant therapy. Our case demonstrates the need for these new techniques in tumours of atypical location and aggressive course. Otherwise, this malignancy may be underdiagnosed until an advanced stage.

Rare Presentation of Small Bowel Obstruction Secondary to Intestinal Leiomyoma in a Patient with Crohn's Disease

Small bowel obstructions (SBOs) are surgical emergencies that can occur with mechanical blockage of the intestinal lumen. These blockages are most commonly caused by adhesions or hernias, but can also result from intestinal neoplasms. This case report documents the rare occurrence of SBO due to a submucosal leiomyoma. This case was complicated by the patient's longstanding history of Crohn's disease, which has a considerable overlap in symptomatology with SBOs. This may have resulted in a delay in the patient's diagnosis. Leiomyomas should always be considered as a potential, albeit rare, cause of SBO.

Radiological and histological findings of an asymptomatic ever-increasing neoplasm: The small bowel neuroendocrine tumor (NET)

The small bowel neuroendocrine tumor is a rare but ever-increasing tumor, most of the time asymptomatic and found incidentally. An early diagnosis can consistently change the prognosis.

Small-bowel capsule endoscopy in patients with unexplained chronic abdominal pain: a systematic review

BACKGROUND

Patients frequently consult primary care physicians and gastroenterologists when experiencing chronic abdominal pain. Although its diagnostic efficacy in these settings is uncertain, small-bowel capsule endoscopy (SBCE) has been used to evaluate the unexplained reasons for abdominal pain.

OBJECTIVE

To evaluate the diagnostic yield of SBCE in patients with unexplained chronic abdominal pain.

DESIGN

We performed a retrospective review of publications reporting the diagnostic yield of SBCE in patients with unexplained chronic abdominal pain and calculated the overall diagnostic yield.

SETTING

Two investigators independently searched studies from databases and analyzed the results.

PATIENTS

A total of 1520 patients from 21 studies were included.

INTERVENTIONS

Small-bowel capsule endoscopy.

MAIN OUTCOME MEASUREMENTS

Per-patient diagnostic yield, with 95% confidence intervals (CI), was evaluated by a random-effect model. Clear categorical analysis also was performed.

RESULTS

The pooled diagnostic yield of SBCE in patients with unexplained chronic abdominal pain was 20.9% (95% CI, 15.9%-25.9%), with high heterogeneity (I(2) = 80.0%; P ＜ .001). Inflammatory lesions were the most common (78.3%) positive findings, followed by tumors (9.0%).

LIMITATIONS

Heterogeneity among studies, retrospective design, variable chronicity of abdominal pain, and different previous examinations before SBCE.

CONCLUSION

SBCE provides a noninvasive diagnostic tool for patients with unexplained chronic abdominal pain, but the diagnostic yield is limited (20.9%). Among patients with positive findings, inflammatory lesions are the most common.

An elusive etiology of upper gastrointestinal bleeding in a young man: testis tumor

Herein, we present a case of testicular tumor in a young patient in whom the initial symptom was upper gastrointestinal bleeding secondary to duodenal invasion by retroperitoneal lymph node involvement. Although melanoma, renal, breast, bronchogenic, and gastric carcinoma are the most common metastatic tumors of the small bowel, testicular tumors should be considered in the differential diagnosis of duodenum invasion in a young man because they are the most common tumor in this age group.

Intraductal papillary mucinous neoplasm originating from a jejunal heterotopic pancreas: report of a case

We report a rare case of an intraductal papillary mucinous neoplasm (IPMN) originating from a jejunal heterotopic pancreas, found incidentally during surgery. A 75-year-old woman was referred to our department for surgical treatment of an abdominal aortic aneurysm (AAA) and a concurrent oropharyngeal tumor. During surgery to correct the AAA, we found a jejunal tumor incidentally and performed partial resection of the jejunum. Microscopically, the jejunal tumor showed dilated ducts containing intraluminal papillae lined with mucinous epithelium with low-grade cytological and architectural atypia within the pancreatic tissue. Immunohistochemical staining revealed MUC1 (-), MUC2 (-), MUC5AC (+), and MUC6 (-) proteins. To the best of our knowledge, only six cases of IPMN originating from a heterotopic pancreas have been reported in English, and this is the first report of an IPMN originating from a jejunal heterotopic pancreas.

Signet Ring Cell Lymphoma of the Small Bowel: A case report

Gastrointestinal lymphoma of the bowel is uncommon compared to adenocarcinoma. Signet ring cell lymphoma (SRCL) is a rare variant of non-Hodgkin's lymphoma that is characterized by clear cytoplasm with displaced nuclei to the periphery giving a signet ring appearance. Small bowel involvement has not been previously reported. We report the rare case of a 78-year-old female who presented with short history of fever, loss of appetite, nausea, vomiting, mild weight loss with abdominal discomfort and was later diagnosed to have SRCL of the ileum.

Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis from small bowel adenocarcinoma

INTRODUCTION

Peritoneal carcinomatosis (PC) is associated with a dismal prognosis. Small bowel adenocarcinoma is a rare etiology for PC. Due to the rarity, poor prognosis, and lack of standard treatment, we chose to review our experience with this disease process treated with cytoreductive surgery (CS) and intraperitoneal hyperthermic chemotherapy (IPHC).

METHODS

From a prospective database of IPHC patients, six patients diagnosed with PC from adenocarcinoma of the small bowel were identified. Between 1995 and 2004 these patients underwent CS and IPHC with Mitomycin C. A retrospective review was performed on these patients with mortality as the primary outcome measure.

RESULTS

Three of the six patients in this series are still alive, with a mean follow-up of 19.7 months after treatment with CS and IPHC. Three patients died of disease progression 29, 30, and 45 months after IPHC. Median survival after diagnosis of small bowel adenocarcinoma was 54 months, while median survival after CS and IPHC for PC was 30.1 months.

CONCLUSIONS

Small bowel adenocarcinoma with PC remains an unusual therapeutic challenge. Treatment with CS and IPHC is an attractive option for patients in this setting.