Neoplasms of the small intestine – diagnostic difficulties

Introduction: A wide spectrum of symptoms of neoplasms of the small intestine results in the lack of pathognomonic symptoms and the diagnosis frequently requires many specialist examinations. This paper presents diagnostic difficulties encountered in 3 patients with such neoplasms. Clinical cases: One case of leiomyosarcoma and two cases of adenocarcinoma of the small bowel are described. All these patients presented with abdominal pain, obscure gastrointestinal bleeding and microcytic anemia. Two patients had a considerable weight loss and one was operated due to ileus. The time that elapsed from the onset of symptoms to the final diagnosis ranged from 10 months to 2 years. The diagnosis of leiomyosarcoma was based on laparotomy and that of adenocarcinoma on newer endoscopic techniques such as capsule and double-balloon enteroscopy. All patients are alive and free of neoplastic disease from 4 to 6 years after the surgical resection of their tumors. Conclusion: Despite their low incidence small bowel malignancies should be taken into account in the differential diagnosis of gastrointestinal bleeding and weight loss in patients with negative results of conventional upper and lower gastrointestinal endoscopies. Newer endoscopic techniques are particularly useful for the diagnosis of such tumors.