Benign Neoplasm of the Small Intestine Workup

Updated: Nov 06, 2015
  • Author: Shawn M Terry, MD, FACS; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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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.

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Imaging Studies

Radiography

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 gastrointestinal [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).

Barium enema helps identify distal ileal lesions with successful reflux of contrast through the ileocecal valve. [26]

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 a 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. (See the image below.)

Benign neoplasm of the small intestine. Arteriogra 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.

Computed tomography

In reports, computed tomography (CT) images of the abdomen demonstrate up to 27% of benign small-bowel tumors. Gut stromal tumors larger than 2 cm are frequently imaged successfully by using CT. Accurate size, evidence of ulceration, and lesion necrosis are often detected.

Ultrasonography

Ultrasonographic images of the abdomen may demonstrate larger tumors (>4 cm) and can help differentiate intraluminal, intramural, and extraluminal growth patterns. [27]

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Endoscopy

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. [28]

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. (See the image below.)

Benign neoplasm of the small intestine. Intraopera 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.

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. [20, 29, 30, 31, 32] 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.

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