eMedicine Specialties > General Surgery > Abdomen

Benign Neoplasm of the Small Intestine: Differential Diagnoses & Workup

Author: Shawn M Terry, MD, FACS, Clinical Assistant Professor of Surgery, Penn State University College of Medicine; Consulting Staff, Department of Trauma and Surgical Critical Care, York Hospital
Coauthor(s): Thomas Santora, MD, Associate Professor, Director of Regional Resource Trauma Center, Department of Surgery, Temple University Medical Center
Contributor Information and Disclosures

Updated: Jul 11, 2008

Differential Diagnoses

Carcinoid Tumor, Intestinal
Intestinal Polypoid Adenomas
Colon Cancer, Adenocarcinoma
Intestinal Pseudo-obstruction: Surgical Perspective
Colonic Obstruction
Peutz-Jeghers Syndrome
Colonic Polyps
Villous Adenoma
Intestinal Perforation

Workup

Laboratory Studies

  • Results from routine laboratory testing do not reveal abnormalities in most patients with small bowel tumors.
  • Microcytic anemia may be observed in conjunction with vascular or ulcerated bleeding lesions.
  • Electrolyte abnormalities are not commonly identified in patients with small bowel tumors.

Imaging Studies

  • Findings from plain films of the abdomen are frequently normal.
  • Larger lesions may demonstrate signs of complete or partial small bowel obstruction (eg, dilated small bowel, air-fluid levels, volvulus).
  • Barium contrast studies (eg, upper GI series, small bowel enteroclysis) are the most frequently used diagnostic tools.
  • Images from upper GI series may demonstrate the lesion in up to 29% of cases.
  • The radiographic appearance on upper GI series includes irregular mucosal surfaces, extraluminal, barium-filled cavities (showing central lesion necrosis), and dumbbell-shaped lesions (indicating intraluminal and extraluminal growth).
  • In reports, CT scan images of the abdomen demonstrate up to 27% of benign small bowel tumors.
  • Gut stromal tumors larger than 2 cm are frequently imaged successfully using a CT scan. Accurate size, evidence of ulceration, and lesion necrosis are often detected.
  • Ultrasound images of the abdomen may demonstrate larger tumors (>4 cm) and can help differentiate intraluminal, intramural, and extraluminal growth patterns.
  • Barium enema helps identify distal ileal lesions with successful reflux of contrast through the ileocecal valve.

Procedures

  • Upper endoscopy/intraoperative enteroscopy
    • Upper endoscopy has been used successfully in the detection of proximal benign small bowel lesions in 12-30% of reported cases.
    • For more distal small bowel lesions, intraoperative enteroscopy is an effective technique that allows simultaneous palpation and visualization of the small bowel in its entirety to increase the possibility of lesion identification.
    • Endoscopy allows concomitant biopsy of intraluminal lesions. Polypectomy may also be performed for small lesions.
    • Gut stromal tumors and lipomas frequently cannot be removed via endoscopy because of their deep intramural location and the subsequent elevated risk of bowel perforation during attempted removal. In addition, some authorities caution against endoscopic lesion biopsy because of the increased risk of shedding cells, which could lead to nests of local tumor recurrence.
  • Capsule endoscopy
    • The newer modality of capsule endoscopy has been successfully used to detect small bowel lesions that have previously remained undiagnosed by other methods.
    • Both color video images and transit time values can be analyzed for regional mucosal abnormalities.
    • Solid benign tumors, such as leiomyomas, as well as vascular lesions (eg, angiodysplasia, varices), have been identified in patients through the use of capsule endoscopy.
  • Arteriography
    • Selective arteriography may be used to aid in the diagnosis of possible vascular lesions and potential embolization of active bleeding.
    • Both subserosal tumors and hemangiomas may be identified by characteristic tumor blush visualized on arteriograms. Additional clues include multiple feeding arteries, irregular draining veins, and venous pooling around the lesion.
  • Arteriography may assist in differentiating malignant lesions from benign lesions. Benign tumors frequently receive arterial supply from either the gastroduodenal artery or the superior mesenteric artery. Malignant lesions often demonstrate aberrant arterial inflow from renal arteries, lumbar arteries, or both.

More on Benign Neoplasm of the Small Intestine

Overview: Benign Neoplasm of the Small Intestine
Differential Diagnoses & Workup: Benign Neoplasm of the Small Intestine
Treatment & Medication: Benign Neoplasm of the Small Intestine
Follow-up: Benign Neoplasm of the Small Intestine
Multimedia: Benign Neoplasm of the Small Intestine
References
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References

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Further Reading

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Keywords

small bowel polyps, small bowel hemangioma, small bowel lipoma, small bowel, leiomyoma, hyperplastic polyps, adenomas, gut stromal tumors, GI stromal tumors, gastrointestinal tumor, Peutz-Jeghers syndrome, duodenal tumor, jejunal tumor, ileal tumor, polyposis syndrome, intraluminal lesions, serosal lesions, bowel obstruction, bowel volvulus, small bowel lesions, GI lesions, gastrointestinal lesions, GI hamartomas, gastrointestinal hamartomas, polyps

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Contributor Information and Disclosures

Author

Shawn M Terry, MD, FACS, Clinical Assistant Professor of Surgery, Penn State University College of Medicine; Consulting Staff, Department of Trauma and Surgical Critical Care, York Hospital
Shawn M Terry, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, Eastern Association for the Surgery of Trauma, Pennsylvania Medical Society, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Thomas Santora, MD, Associate Professor, Director of Regional Resource Trauma Center, Department of Surgery, Temple University Medical Center
Thomas Santora, MD is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, American Trauma Society, Association for Academic Surgery, and Society for Surgery of the Alimentary Tract
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Amy L Friedman, MD, Professor of Surgery, Director of Transplantation, State University of New York Upstate Medical University College of Medicine, Syracuse
Amy L Friedman, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Medical Women's Association, American Society for Artificial Internal Organs, American Society of Transplant Surgeons, American Society of Transplantation, Association for Academic Surgery, Association of Women Surgeons, International College of Surgeons, International Liver Transplantation Society, New York Academy of Sciences, Pennsylvania Medical Society, Philadelphia County Medical Society, Society of Critical Care Medicine, and Transplantation Society
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other; AstraZeneca Grant/research funds Other

 
 
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