Malignant Tumors of the Small Intestine

Abstract

Hough malignant tumors occur much more uncommonly in the small intestine than in other parts of the gastrointestinal tract, they are no longer considered so rare as in the past. As a result of renewed interest in the study of the small bowel during the past decade, they are being discovered preoperatively with increasing frequency. Roentgen examination is of prime importance in their diagnosis, and generally speaking no other method approaches it in accuracy of localization and differentiation. Tumors of the duodenum and upper jejunum are frequently discovered during routine gastric examination, but those occurring below that level usually require a special small bowel study. Roentgen examination of the small intestine is a time-consuming procedure, demanding the utmost attention to detail. The observer must constantly bear in mind the possibility of a tumor and must be alert for the roentgen signs which indicate its presence. The procedure varies somewhat with the individual patient, but in general is as follows. On the morning of the examination, breakfast is omitted and the patient is also requested to abstain from fluids if possible. Four ounces of barium sulfate suspended in 8 ounces of water are administered, and a fluoroscopic study of the esophagus and stomach is made, as much barium as possible being forced through into the duodenum so that a complete duodenal examination can also be accomplished at this time. Fluoroscopy is then carried out at thirty-minute intervals, and films are obtained, until all the barium has left the small bowel, except when there is evidence of obstruction, in which event the time between observations and the total examination time are determined by the motility as observed at the interval examinations. The fluoroscopic study is of the greatest value in demonstrating all of the intestinal coils and calling attention to any suspicious areas. Films are made routinely in the prone position. Golden (4) states that he has never encountered any damage from the administration of barium sulfate by mouth in the presence of lesions of the small intestine. The small bowel contents remain fluid and can be removed by suction if necessary. A preliminary barium enema to rule out lesions of the colon is advisable in all cases with a history suggesting possible obstruction. General Considerations Pathology: Ewing (2) mentions three forms of small intestinal carcinoma: (i) a part of a local or generalized intestinal polyposis, (ii) localized adenocarcinoma with carcinomatous variations in structure, and (iii) carcinoid tumor. These tumors tend to produce various changes in the intestinal lumen depending upon their origin and mode of growth. Two principal types occur: (a) the constricting type, which consists essentially of a small, localized, infiltrating growth producing early mechanical obstruction by narrowing the intestinal lumen