[Neoplastic small bowel obstruction: our experience with 21 cases and review of the literature]

Abstract

Small bowel tumours are rare, representing 0.3% of all cancers. The main problem with these tumours is that they induce vague, non-specific symptoms, causing a delay in diagnosis, which is often reached in cases of acute complications such as intestinal obstruction. Moreover, the small bowel is often involved secondarily by tumours that actually start from adjacent organs or by processes of peritoneal carcinomatosis, conditions which are responsible for a distinct worsening of the prognosis (up to 70% mortality). The aim of the study was to define the indications and the most appropriate surgical treatment modalities depending on the presentation of the small bowel tumour. At the Emergency Surgery Unit of the Vittorio Emanuele, Ferrarotto and S. Bambino Hospital in Catania 21 cases of intestinal obstruction caused by small bowel tumours were observed out of a total of 335 patients affected by intestinal occlusion (1.6%). Thirteen patients (62%) had already undergone abdominal surgery for a malignant neoplasm. All patients underwent plain abdominal X-ray which showed air-fluid levels; 14 (66%) were additionally studied by CT scans. Thirteen patients were operated on immediately on the day of admission, while the other 8 were initially treated conservatively. The small bowel was the primary site of the neoplasm only in 3 cases; in the other 10 it was secondarily involved by tumours originating from adjacent organs or by peritoneal carcinomatosis. In 8 cases an intestinal resection was accomplished together with removal of the involved organs, while in the 5 cases of carcinomatosis simple diverting procedures were carried out. Of the 8 patients initially treated conservatively, 6 were subsequently submitted to diverting operations because of persistence of the occlusive status. Nine patients had postoperative complications (47%) and another 3 died (14%). In conclusion, intestinal obstruction is a frequent complication of small bowel tumours, especially if they are in the final stages. Intestinal resection offers a good chance of recovery in cases--unfortunately rare--of confined tumours; in the other instances it is preferable to perform diverting procedures and subsequently refer the patient to the oncologist in order to plan adjuvant therapy, if possible.