Primary neoplasms of the small intestine.

Over a 20 year period, 64 patients with primary neoplasms of the small intestine were treated by celiotomy (61 patients) or surgical endoscopy (3 patients). Gastrointestinal bleeding and anemia (38 percent of patients) characterized benign lesions, whereas pain (42 percent), nausea and vomiting (26 percent), weight loss (29 percent), and either gastrointestinal obstruction or jaundice (18 percent) were more indicative of malignancy. Barium studies, duodenal endoscopy, and selective angiography were the most useful diagnostic tools. All 26 patients with benign lesions did well after resection, whereas the 38 patients with malignancies did poorly despite apparently curative wide excision in 19 and pancreaticoduodenectomy in 6. Only the patients with malignant carcinoid lesions treated surgically and by chemotherapy had a good 5 year survival rate (60 percent). All patients with sarcomas and adenocarcinomas died from their disease. Major operations and chemotherapy gave fair outcomes in only a minority of patients who had no evidence of metastasis. These results document the need to suspect small intestinal neoplasms earlier and to perform more aggressive diagnostic workups in patients with vague gastrointestinal symptoms.