The influence of a Federal comprehensive health care system on the detection and outcome of primary small bowel malignancies.

Twenty-one cases of primary small bowel malignant tumors treated at our institution from 1983 to 1993 were reviewed. The mean age at diagnosis was 51.6 +/- 16.8 years. Twelve patients (57%) reported symptoms of less than 1 month duration. Diagnosis was made at laparotomy in 13 patients (62%), and nine patients (43%) had three or more preoperative studies. Five patients (24%) presented with abdominal emergencies. The 5-year survival rate for the series was 19 per cent. This study was performed at a tertiary care military hospital where patients and physicians are not subjected to the financial constraints of civilian health care. This system should eliminate delays in seeking medical care and expedite diagnosis. Despite almost immediate medical attention for a majority of the patients, overall survival is not significantly different from that in previous reviews. This study emphasizes that the presentation of small bowel malignancies is indolent and difficult to diagnose. Prognosis remains poor despite the patient cost-free system and almost immediate medical attention. This study suggests that a high index of suspicion and a thorough evaluation, including laparotomy, are required to improve outcome.