Benign Neoplasm of the Small Intestine Workup

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

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.

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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.[23]

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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.[24]

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. Note the image below.

Benign neoplasm of the small intestine. IntraoperaBenign neoplasm of the small intestine. Intraoperative view of an ependymal small bowel stromal tumor. Notice the narrow lesion stalk and high degree of vascularity.

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.[18, 25, 26] 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. Note the image below.

Benign neoplasm of the small intestine. ArteriograBenign neoplasm of the small intestine. Arteriogram demonstrating small bowel gut stromal tumor, indicated by round tumor blush in lower right corner of the image.
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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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