title: [Small bowel tumours from barium meal to capsule endoscopy and from open to laparoscopic approach].
abstract: BACKGROUND
  Tumors of the small bowel are rare and present with nonspecific symptoms. That causes a significant delay in diagnosis and consequently a worse outcome for the patient.
  
  
  METHODS
  In a retro-prospective study we evaluated a series of 63 patients with small bowel tumors operated in the First Surgical Clinic Iaşi, during 1992-2010: 18 duodenal tumors, 26 jejunum tumors and 19 ileum tumors. There were 18 (28.6%) cases with benign tumors and 45 (71.4%) cases with malignant tumors (41 primary tumors and 4 secondary tumors). We discuss problems related to diagnosis, treatment and prognosis of these tumors in the presence of new explorations (capsule endoscopy, enteroscopy) and minimally invasive approach.
  
  
  RESULTS
  Duodenal tumors were malignant in 14 cases (11 adenocarcinomas, 3 malignant GIST tumors) and benign in 4 cases (adenoma, lipoma, GIST tumor, schwannoma) which led to stenosis in 5 cases, upper gastrointestinal bleeding in 3 cases. Positive diagnostic was confirmed with barium meal and endoscopy. The jejunal and ileal tumors were mostly malignant 31 cases (13 carcinomas, 10 lymphomas, 2 malignant GIST and one sarcoma) with only 14 cases of benign tumors (5 GIST). Their tendency was to present as emergencies: 17 obstructions and 5 peritonitis. Modem imagistic proved useful as diagnostic tool: capsule endoscopy, CT-scan and enteroscopy. The benign tumors benefited from local resection (5 cases) and segmental enterectomy (12 cases), while malignant tumors were managed using Whiple's procedures (10 cases), duodenal-jejunal resections (1 case), segmental enterectomy (29 cases), ileocolectomy (2 cases) and three bypasses. Laparoscopic approach was performed in 8 cases.
  
  
  CONCLUSIONS
  The incidence of small bowel tumors remains low. For diagnosis, CT-scan, enteroscopy and capsule endoscopy are very useful; unfortunately the last method is not practicable in emergency. Surgery is the best choice plus chemotherapy for some malignant tumors. Laparoscopic approach is feasible in selected cases.
authors: Clinica I Chirurgie "I. Tănăsescu - Vl. Buţureanu", Universitatea de Medicină si Farmacie "Gr. T. Popa" Iaşi, România. etarcov@yahoo.com
authors: E
authors: E
authors: Târcoveanu
authors: St
authors: S
authors: Georgescu
authors: A
authors: A
authors: Vasilescu
authors: N
authors: N
authors: Dănilă
authors: C
authors: C
authors: Lupaşcu
authors: G
authors: G
authors: Dimofte
authors: C N
authors: CN
authors: Neacşu
authors: R
authors: R
authors: Moldovanu
mesh_terms: D001466:Barium Sulfate; D053704:Capsule Endoscopy; D003287:Contrast Media; D004379:Duodenal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007078:Ileal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D007421:Intestine, Small / Q000473:pathology / Q000601:surgery; D007580:Jejunal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate