A shift in the diagnostics of the small intestine tumors.
Primary, secondary, benign or malignant tumorous diseases of the small intestine are rare. They are very often diagnosed by accident or as a cause of acute abdomen. This work should answer the question, whether there is a method of making the diagnosis earlier when the disease is limited and easy to cure.


METHODS
A retrospective study comprising 96 patients having undergone surgery for a small intestine tumor in our hospital from 1996 to 2005 is presented. An analysis of first symptoms, diagnostic methods and number of patients admitted during the years was made. In the year 1998 we changed our philosophy in trying to directly detect the small intestine pathology and not making the diagnosis by the exclusion only. Intestinal ultrasound was performed on the Ultramark 3000 HDI device with autofocussable convex 5 MHz and linear 7.5 MHz probes or nowadays ATL 5000 HDI, 7-12 MHz linear probe. No contrast enhancement was used. Abdominal CT engaged Somatom Plus appliance by Siemens, single detector with our conventional abdominal CT protocol. Enteroclysis was done with Micropaque suspension diluted 1:1 with HP-7000 300 ml with its application rate of 75 ml/min followed by HP-7000 solution 2000 ml, application rate of 120 ml/min.


RESULTS
We treated surgically 96 patients with the small intestine tumor. A shift in the diagnostic algorithm was noticed in the bowel ultrasound now taking the lead. An enlarged portion of patients diagnosed by means of capsule endoscopy was also seen. An increase of surgically treated patients after 1998 was recorded and the majority of them could be offered an elective laparoscopic surgery in contrast to before 1998 when the majority of them had undergone surgery for an acute abdomen.


CONCLUSIONS
The small bowel ultrasound can be recommended as the first choice method. All patients with even very moderate abdominal symptoms ought to be examined for the small intestine pathology. As a result one can get higher rate of elective surgery, if possible laparoscopic and higher number of R0 resections accompanied by longer survival.
Kala
Zdenek
Z
Department of Surgery, Faculty Hospital Brno, Jihlavska 20, 62500 Brno, Czech Republic. zdkala@tiscali.cz
Válek
Vlastimil
V
Kysela
Petr
P
Svoboda
Tomás
T
D000006:Abdomen, Acute / Q000209:etiology / Q000601:surgery; D000230:Adenocarcinoma / Q000175:diagnosis / Q000601:surgery; D000368:Aged; D000465:Algorithms; D002276:Carcinoid Tumor / Q000175:diagnosis / Q000601:surgery; D018153:Czech Republic; D016099:Endoscopy, Gastrointestinal; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D007414:Intestinal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D010535:Laparoscopy; D008223:Lymphoma / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed