Benign Neoplasm of the Small Intestine Treatment & Management

  • Author: Shawn M Terry, MD, FACS; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: Nov 28, 2011
 

Medical Care

Strict medical management currently has no role in benign small bowel tumors. Patients with suggestive abdominal pain, particularly if associated with evidence of anemia or intermittent obstruction, should be referred for surgical evaluation and management. Asymptomatic evidence of small bowel mass, stricture, or intermittent obstruction discovered on incidental radiographs should be referred for surgical evaluation.[27]

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Surgical Care

Surgical excision of small bowel tumors remains the recommended therapy. Exploratory laparotomy with excision of the lesion provides the safest and most direct method for lesion identification and treatment.

Tumors discovered incidentally at laparotomy should be removed to prevent future symptom development and secondary complications.

Both segmental resection and enterotomy/polypectomy have been used for lesion removal. If the pathology cannot be established at the time of resection, full segmental resection with adequate margins is recommended. Note the image below.

Benign neoplasm of the small intestine. Cross sectBenign neoplasm of the small intestine. Cross section of a gross ependymal small bowel stromal tumor after removal. Mixed stromal elements and a high degree of cellularity are apparent.

Literature confirms an excellent prognosis for tumors resected prior to tumor perforation or onset of massive GI hemorrhage.

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Consultations

Consultations with either gastroenterology or general surgery may be helpful when abdominal pain of unknown origin or suspicion of small bowel pathology exists so that the patient may benefit from full endoscopy, capsule endoscopy, or intraoperative push enteroscopy.[28]

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Diet

No special dietary recommendations are applicable.

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Activity

Activity is generally as tolerated for the patient. If the patient requires operative exploration for a benign small bowel tumor, the postoperative activity regimen should follow the recommendation of the operative surgeon.

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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 Emergency General Surgery, Community Medical Center

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  Professor and Vice-Chair for Clinical Affairs, Department of Surgery, Temple University Hospital, Temple University School of Medicine

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 Eastern Association for the Surgery of Trauma

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

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 Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, 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 Consulting; ARdelyx Ownership interest Board membership

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Benign neoplasm of the small intestine. Arteriogram demonstrating small bowel gut stromal tumor, indicated by round tumor blush in lower right corner of the image.
Benign neoplasm of the small intestine. Intraoperative view of an ependymal small bowel stromal tumor. Notice the narrow lesion stalk and high degree of vascularity.
Benign neoplasm of the small intestine. Cross section of a gross ependymal small bowel stromal tumor after removal. Mixed stromal elements and a high degree of cellularity are apparent.
 
 
 
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