Stomach Bowel Research Articles

Tumours of the small bowel

A series of small bowel neoplasms was reviewed from the Otago Medical School and Dunedin Hospital Departments of Pathology and Surgery. The series comprised a total of 55 cases occurring between 1954 and 1968, and the material was obtained from both necropsies and surgical resections. There were 41 malignant and 14 benign lesions. Clinical features and behaviour were reviewed briefly; intussusception was a common presenting feature. The benign tumours included 5 examples of adenoma, 4 of leiomyoma, 2 of lipoma, 2 of lymphangioma and 1 of haemangioma. There were 31 primary malignant tumours, including 13 examples of argentaffin carcinoma, 11 of adenocarcinoma, 5 of lymphoma, 1 of leiomyosarcoma and 1 of squamous carcinoma. Ten instances of metastatic disease were encountered, seven of which were from melanomata and the other three from lymphomata. The prognosis in the series appeared to be unaffected by the mode of presentation or surgical treatment.

A comparative electron microscopic study of human and rat colonic polyps and carcinomas

Colonic polyps and carcinomas of rats induced by 3-2′-dimethyl-4-aminodiphenyl were studied electron microscopically and compared to similar human lesions. Both showed significant alterations of microvilli, desmosomes, and nuclei when compared to the normal. However, altered goblet cells were observed in the lesions of the rat but not in the human neoplasms. Large dense cellular inclusions were noted in the rat cecal mucosa and a polyp and in the human polyps and carcinomas. Small, dense, loose groups of intranuclear bodies were seen in two human carcinomas. Their nature was not evident. The electron microscopic findings represent another area of similitude between an experimental model for the study of large bowel neoplasms and the human.

Carcinoid tumors of the small bowel.

CARCINOID tumors were first described approximately 100 years ago but the nature and clinical significance of this lesion was not understood until the beginning of the last decade. Langhans,1Lubarsch,2and Ransom,3in the late 19th century, were among the first observers to describe these tumors. The Kultschitzky cell was incriminated as the origin of the tumor by Gosset and Masson4after Oberdorfer5named the lesion in the early 20th century. Elucidation of serotonin, its pharmacology, and association with carcinoid tumors during recent years has stimulated the clinician, pharmacologist, physiologist, and biochemist to correlate their findings to give added impetus regarding the knowledge of this disease. Carcinoids have been reported in 0.2% of all routine autopsies and constitute approximately 10% of all small bowel neoplasms.6,7Prior to 1939 there were no reported cases of carcinoid tumor diagnosed preoperatively, and since that time only a

Considerations on 42 cases of lymphoreticular tumors of the gastrointestinal tract

Forty-two cases of lymphoreticular tumors of the gastrointestinal tract are reported: 27 reticulosarcomas, 10 lymphosarcomas, 3 lymphoreticulosarcomas and 2 cases of Hodgkin's disease. The localization was the following; 28 tumors of the stomach, 9 of the small intestine, 3 of caecum and 2 of rectum. The age of the patients ranged from 17 to 64 years. The study of the cases indicates that it is difficult, if not impossible, to obtain a correct diagnosis before surgical operation, as all the common diagnostic measures, except biopsy, are not probative. The results of therapeutical treatment, which consisted, when possible, of radical dissection of the tumors, followed by roentgentherapy, are reported. The tumors of the stomach showed a high rate of operability (19 of 28 cases were radically operated). Two of 3 cases of tumor of caecum and 3 of 9 tumors of the small bowel were amenable to surgery. The survival rate of the cases in which the stomach was involved was fairly good (6 patients of 22 were alive after 5 years, and 5 of 14 after 10 years). As to the patients with a tumor of the small bowel, 6 of 9 died within 1–2 years.

Tumors of the small intestine.

We should be able to improve our diagnostic acumen in cases of tumors of the small bowel. Obscure abdominal symptoms should bring to mind the possibility of small-bowel neoplasm and point to the need for a careful radiographic examination. The persistent presence of occult blood in the stool justifies laparotomy even in the absence of positive radiographic findings.

Villous Tumors of the Lower Part of the Large Bowel

With the thought that many noninvasive villous tumors of the large bowel are amenable to conservative treatment (local excision, fulguration, and radium application), 205 cases were studied in which conservative treatment was advocated during the period 1950 through 1963. Conservative treatment was successful (1- to 12-year follow-up) in 98% of 194 cases (1% lost to followup). Examination of surgical specimens from 11 patients treated by radical operation showed that conservative treatment probably would have been adequate, since lesions were confined to the mucosa. Removal from below, either by surgical or thermal means, constitutes safe and adequate treatment for most noninvasive villous tumors of the lower portion of the bowel.

Cancer of the Colon, Rectum and Anal Canal.

I have had this book available for four months and had not previously completed a review, for it has so very much in it that I could not really get into it to learn its value and content. The initial chapters are devoted to the surgical anatomy, physiology, and etiology of cancer and are the weaker chapters of the book. We are then carried through a detailed but highly usable discussion of all the benign and malignant tumors of the large bowel. The text is so highly usable because it is filled with illustrations from the literature or the author's own intensive experience. Multiple series are quoted, both in favor of and against the author's view. In each section, treatment is presented in a straight-forward manner, choosing one of several paths, and available data are given for the follow up employing each form of treatment. Each small section has a

COMPLETE REFLUX SMALL BOWEL EXAMINATION.

The Many different methods of small bowel examination recorded in the literature indicate that these are not as rapid or as exact as we would like (1–19). While the radiographic study of the colon and stomach is highly accurate when performed by competent examiners, the antegrade small bowel examination lacks this precision. For example, tumors of the small bowel are frequently not discovered until obstruction or other symptoms force an exploratory laparotomy. Most physicians hope for some improvement in this area, and we believe the complete reflux small bowel examination is a step forward. In our experience this new procedure is easier, quicker, and more fruitful than the older methods. This new method has demonstrated small ulcerations and inflammatory strictures of the small bowel as well as several other complete and incomplete obstructions: Meckel's diverticula (one inverted), a radiolucent gallstone causing obstruction, adhesive bands, small bowel fistulae, and the extent of disease in regional ent...

Neurofibromatosis of the small bowel

Neurogenic tumors of the small bowel are uncommon. In general, the roentgen manifestations of all submucosal tumors are similar. The present case presented with abdominal pain, pelvic mass, and intussusception. After several small-bowel studies multiple intraluminal and intramural filling defects due to neurofibromas were finally demonstrated.

Tumors of the small bowel

1. 1. A total of thirty-six primary tumors of the small bowel, twelve malignant and twenty-four benign, were treated over a period of thirty-three years. Of these, eighteen were discovered incidentally at autopsy or in surgical specimens extirpated for other lesions, and eighteen produced symptoms leading to their detection. 2. 2. Benign tumors of the small bowel often are asymptomatic, but malignant neoplasms almost always produce symptoms. Gastrointestinal bleeding, abdominal pain or intestinal obstruction are the usual presenting syndromes. Pain is by far, the most common symptom and is usually epigastric, recurrent and crampy. The presence of anemia strongly suggests that the small bowel neoplasm is malignant, as does a palpable abdominal mass. 3. 3. Roentgenologic study undertaken in sixteen patients provided evidence of small bowel derangement in ten instances. The studies performed were plain films of the abdomen, roentgenograms of the stomach and duodenum, small bowel series and barium enema examination. 4. 4. Surgical excision is the preferred treatment for all patients with neoplasms of the small bowel. Excision for malignant lesions should include wide resection of the adjacent mesentery. Radiation also has been suggested for lymphoid tumors. 5. 5. Of twelve patients with malignant small bowel neoplasms only two are known to be free of disease. These patients had leiomyosarcoma and a carcinoid tumor, and are living twenty-five and thirty months, respectively. Both of these are slow growing neoplasms, and the patients cannot be considered cured at this early date. 6. 6. Of the malignant small bowel neoplasms leiomyosarcomas and carcinoid tumors have the longest survival time and adenocarcinomas and lymphosarcomas the shortest.

The surgical management of massive melena

When melena is associated with hematemesis its source is usually proximal to the ligament of Treitz. When melena occurs alone the bleeding may arise anywhere from the esophagus to the rectum. Operation is advised when the melena is obviously exsanguinating, persistent or repeatedly recurring. Many of the lesions causing melena can be diagnosed clinically. Their treatment will depend on the nature of the disease. In other patients a diagnosis cannot be made by the usual methods. In this group we advise diagnostic laparotomy while the bleeding is active, before the bleeding recurs too many times. In this manner bleeding Meckel's diverticula, extramural small bowel neoplasms, etc. may be discovered. If a lesion cannot be found, the highest level of intraluminal blood may serve as a guide to the bleeding point. Multiple enterotomies and colotomies are performed and the adjacent mucosa is intussuscepted into the opening in the bowel wall. If still no lesion is found, intestine containing obvious disease such as diverticulosis is resected. We believe, however, that in many elderly patients with sclerotic vessels the bleeding arises from rupture of an intestinal submucosal artery rather than from the coincidental diverticular disease. Illustrative case histories are included.

Neoplasms of the small bowel

Tumors of the small bowel are uncommon and comprise about 5% of all gastrointestinal tumors. Carcinoma exceeds sarcoma in frequency, although of the sarcomas which occur in the gastrointestinal tract, 60% are found in the small bowel. Benign tumors of the small intestine are reported as extremely rare because they are more frequently asymptomatic. The early symptomatology is usually that of partial or intermittent intestinal obstruction although complications such as hemorrhage, perforation or complete obstruction may be the first to occur. The correct diagnosis is infrequently made, but should be seriously considered when the characteristic syndrome of a more common disease is bizarre, or whenever barium studies fail to reveal the suspected pathology in cases with anemia and melena. The treatment of small bowel lesions is resection and end-to-end anastomosis, which, except for the fixed portions of the small intestine, is technically simple and should be attended by a low incidence of morbidity and mortality. Al-though carcinomas tend to metastasize earlier than sarcomas, the usual constricting nature of their growth should result in earlier diagnosis and treatment, with a better prognosis than has been reported in the past. This can only be accomplished by constantly keeping the possibility of small bowel tumor in mind. One should never be satisfied with negative gastrointestinal studies once the ominous symptoms and findings of partial intestinal obstruction or melena have been observed.

Different Types of Benign Epithelial Tumors of the Large Bowel

Different Types of Benign Epithelial Tumors of the Large Bowel

CARCINOMA OF THE JEJUNUM AND OF THE ILEUM

Carcinoma of the small bowel is often considered extremely rare. Though it is not common it is more frequent than is usually supposed. Sarcoma, however, is found more often in the lower part of the ileum than in the large bowel. Cancer of the ampulla of Vater and its adjoining tissue increases the incidence of carcinoma of the duodenum. Three types of carcinoma of the jejunum and of the ileum may be considered: (1) the most common, adenocarcinoma; (2) carcinoid, or argentaffin tumor, and (3) melanocarcinoma. The paper by Rankin and Mayo 1 in 1930, a later paper by Rankin and Newell 2 in 1933 and Raiford's 3 articles on tumors of the small intestine in 1931 and 1932 were thorough and interesting. They included reports on tumors of the small bowel occurring almost to the time of publication of the reports. Few cases have been added to the literature

The Roentgenologic diagnosis of tumors of the small bowel

The Roentgenologic diagnosis of tumors of the small bowel

Tumors of the Small Intestine

I.—Introduction TUMORS of the small bowel are conceded by pathologists and surgeons to be of extremely rare occurrence. So infrequent are they, in fact, that the occurrence of two cases on the wards of the Johns Hopkins Hospital during the past year has prompted a survey and study of all tumors occurring in this location in the history of the clinic. This paper deals with the clinical aspects of such tumors, with special reference to the roentgenologic findings. A complete resume of the subject, with a detailed report of all tumors found, is to be published later. The records of this hospital yielded 82 cases of primary tumors located between the pylorus and the ileocecal junction. This comprised 6.5 per cent of all tumors of the gastro-intestinal tract, agreeing roughly with statistics of other writers on the subject. Of this number, 32 (or 40 per cent) were malignant and 50 (or 60 per cent) were benign; 37 per cent gave definite symptoms and were operated upon; 17 per cent gave symptoms but were not ope...

INTRAMURAL INFLAMMATION OF THE COLON SIMULATING CANCER

Recognition of the fact that inflammatory processes ofttimes simulate malignant neoplasms to a remarkable degree is important, not only from a clinical and surgical standpoint, but also because of the fact that prognostic errors, so frequently made in this type of case, cause serious future embarrassment to the surgeon. Well known examples of this similarity obtain in chronic inflammatory masses of the breast, chronic thyroiditis, Mikulicz's disease of the submaxillary glands and various other inflammatory tumors of the muscular, osseous and glandular systems. In no location in the body, however, is the clinical diagnosis more difficult or the prognosis of more importance than in inflammatory tumors of the intestinal tract, the majority of which are found in the colon. The occurrence of these lesions was first reported by Virchow in 1853 when he described isolated inflammatory tumors of the large bowel. Mayo Robson 1 reported several cases in 1908. Hamman