title: Small bowel tumours in emergency surgery: specificity of clinical presentation.
abstract: BACKGROUND
  Despite advances in diagnostic modalities, small bowel tumours are notoriously difficult to diagnose and are often advanced at the time of definitive treatment. These malignancies can cause insidious abdominal pain and weight loss, or create surgical emergencies including haemorrhage, obstruction or perforation. The aim of the present study was to describe the clinical presentation, diagnostic work-up, surgical therapy and short-term outcome of 34 patients with primary and secondary small bowel tumours submitted for surgical procedures in an emergency setting and to look for a correlation between clinical presentation and the type of tumours.
  
  
  METHODS
  From 1995 to 2005, 34 consecutive surgical cases of small bowel tumours were treated at the Department of Emergency Surgery of St Orsola-Malpighi University Hospital, Bologna, Italy. Clinical and radiological charts of these patients were reviewed retrospectively from the department database.
  
  
  RESULTS
  All patients presented as surgical emergencies: intestinal obstruction was the most common clinical presentation (15 cases), followed by perforation (11 cases) and gastrointestinal bleeding (eight cases). Lymphoma was the most frequent histologic type (nine patients), followed by stromal tumours (eight patients), carcinoids (seven patients), adenocarcinoma (seven patients) and metastasis (three patients). Of the nine patients with lymphoma, eight were perforated, all patients with stromal tumours had bleeding, and all carcinoids patients had bowel obstruction. There were two patients with melanoma metastasis, both had bowel intussusception. Resection of the neoplasm was carried out in 32 patients and two patients were deemed unresectable and received a palliative procedure.
  
  
  CONCLUSIONS
  The present study shows that there is a correlation between small bowel tumours and clinical emergency presentation: gastrointestinal stromal tumours (GIST) mostly bleed; carcinoids make an obstruction; lymphomas cause a perforation; and melanoma metastasis causes intussusception.
authors.affiliation: St Orsola-Malpighi University Hospital, Emergency Surgery, Bologna, Italy. fcatena@aosp.bo.it
authors.forename: Fausto
authors.initials: F
authors.lastname: Catena
authors.forename: Luca
authors.initials: L
authors.lastname: Ansaloni
authors.forename: Filippo
authors.initials: F
authors.lastname: Gazzotti
authors.forename: Stefano
authors.initials: S
authors.lastname: Gagliardi
authors.forename: Salomone
authors.initials: S
authors.lastname: Di Saverio
authors.forename: Angelo
authors.initials: A
authors.lastname: De Cataldis
authors.forename: Mario
authors.initials: M
authors.lastname: Taffurelli
mesh_terms: D000230:Adenocarcinoma / Q000150:complications; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002276:Carcinoid Tumor / Q000150:complications; D004636:Emergency Service, Hospital; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D046152:Gastrointestinal Stromal Tumors / Q000150:complications; D006801:Humans; D007414:Intestinal Neoplasms / Q000150:complications* / Q000601:surgery; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D007421:Intestine, Small; D007443:Intussusception / Q000209:etiology; D008223:Lymphoma / Q000150:complications; D008297:Male; D008545:Melanoma / Q000150:complications; D008875:Middle Aged; D009362:Neoplasm Metastasis; D012189:Retrospective Studies