Analysis of small bowel tumors

OBJECTIVE: Small bowel tumors are remarkably rare. The colon is affected 40 times than the small bowel. Even though the small intestine accounts for 80% of the length and 90% of the mucosal surface of the gastrointestinal tract, only 3-6% of the gastrointestinal malignancies arise from the small bowel. The aim of the study is to enlighten the subject in our community including: therapeutic intervention, the histopathologic types, the risk factors and outcome.

METHODS: Between January 1997 and January 2002, 40 patients with primary small bowel tumors were followed in Baghdad Hospital, Gastroenterology and Hepatology Hospital, Al-Mansour Hospital for Pediatrics at Medical City Teaching Centre and the Al-Zahraa Private Hospital, for presentations, preoperative investigations, operative procedures and outcome. Chi-square test or where appropriate Fishers exact test was used to assess for the statistical significance of the site of the tumor and outcome. The relative risk (RR) and odds ratio (OR) where possible, were used to measure the magnitude of developing a certain outcome (like death) in the presence of risk factor compared to its absence. P value less than the 0.05 level of significance is considered statistically significant. The 95% confidence interval was used to express the expected range of incidence rate of certain outcomes in the target population.

RESULTS: The most frequent age group affected is 46-60. The most frequent symptoms in decreasing order were abdominal pain (75%), vomiting (72.5%), and weight loss (52.5%). The most sensitive diagnostic procedure was barium study (84.6%). Lymph nodes were the most common site of metastases 15 (37.5%). The duration of follow up was from 2-60-months. The site: duodenum has the highest case fatality rate (62.5 %) with an RR=9.9 which was statistically significant (p=0.006) as compared to the jejunum (25%) that has an RR=3.9 (p=0.16 NS)], then the ileum (6.3%).

CONCLUSION: Overall, the prognosis for patients with small intestinal tumors is poor. The duodenum as a site of the small bowel tumors was the only significant risk factor with regard to case fatality rate. Despite current advanced diagnostic modalities, the small intestine remains a difficult area to image with both radiographs and the endoscope.