Small intestinal adenoma

Introduction to small intestine adenoma Small intestine adenoma is a benign tumor that occurs in the epithelial or intestinal glandular epithelium of the small intestine. It occurs in the duodenum and ileum. It is small in size, pedicled, and polypoid-like. It is a group of fibroids that cover the mucosa and It is also composed of polypoid-like protrusions in the submucosal layer, so it is also called intestinal polyps. basic knowledge Proportion of disease: 5% of all gastrointestinal malignancies Susceptible people: no specific population Mode of infection: non-infectious Complications: gastrointestinal bleeding, jaundice, anemia, intussusception

Causes of small intestine adenoma

(1) Causes of the disease

Small intestine adenomas occur in the duodenum and ileum, and there are fewer jejunums, usually from the intestinal mucosa epithelium or glandular epithelium, which protrudes into the intestinal lumen. It can be single or multiple, often with pedicles, and its free end often points far. At the end, the size of the adenoma is different. The small ones are only a few millimeters in diameter, and the larger ones can reach 3 to 4 cm.

(two) pathogenesis

Small intestine adenomas, like large intestine adenomas, can be divided into three types according to their histological structure: tubular adenomas, villous adenomas, and mixed adenomas.

Tubular adenoma

Also known as adenomatous polyps or polypoid adenomas, occurring in the duodenum (41.3%), followed by the ileum (34.3%), less jejunum (22.3%), mostly single or multiple, Multiple cases can be concentrated in a small intestine or all small intestines, or even the entire gastrointestinal tract. These adenomas are polypoid, mostly pedicled. According to statistics, 50% of cases of familial colonic polyposis can be associated with small intestine adenoma, many The case is asymptomatic, and the symptoms appear more bleeding, which can also cause intussusception.

2. Villus adenoma

Also known as papillary adenoma, less common than tubular adenomas, most occur in the duodenum, but only account for 1% to 3% of duodenal tumors, starting from the duodenum to the distal bowel Reduced, the volume is larger than tubular adenoma, ranging from 0.5cm to 8.5cm, but most <5cm.

3. Mixed adenoma

Also known as the tubular adenoma of the villus, the above two structures coexist, and the biological behavior is between the two adenomas.

There are also non-neoplastic polyps: hyperlastic polyp and infammatory polyp, which usually disappear on their own, hamartomat polyps such as familial mucosal pigmentation gastrointestinal polyposis (Peutz- Jeghers syndrome (PJS) is a dominant genetic disease characterized by: 1 lip, buccal mucosa, gums, black skin spots on the flexor side of the hands and feet (referred to as black spots), not higher than the skin and mucosal surface, about the size 1 ~ 4cm, mostly in children and adolescence; 2 multiple polyps of the gastrointestinal tract, mostly jejunum, mostly pedicle, histologically a hamartoma; 3 family hereditary, autosomal dominant genetic disease Intussusception is an acute complication of this disease, and a few can be cancerous.

Small bowel adenoma prevention

There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.

Small intestine adenoma complications Complications, gastrointestinal bleeding, jaundice, anemia, intussusception

Gastrointestinal bleeding

The tumor expands and grows to a certain volume, and the tumor rupture causes the blood vessels on the surface of the tumor to collapse and cause bleeding.

2. Huang Wei

Adenomas in the duodenal papilla may cause obstructive jaundice due to compression or obstruction of the lower end of the common bile duct.

Anemia, intussusception is a common complication of small intestine adenocarcinoma, and it is also the main reason for treatment.

Symptoms of small intestine adenoma Common symptoms Abdominal distension, nausea, abdominal pain, pale, dull pain, weight loss, gastrointestinal bleeding, qi diarrhea, black stool

The small intestine has good receptivity, the content is often liquid, and the adenoma generally grows slowly. Therefore, the small intestine adenoma can be asymptomatic for a long time. As the disease progresses, about 50% of the patients have obvious symptoms. More common after complications, the remaining half of the patients were only found during other laparotomy operations or autopsy. The most common manifestations were abdominal pain, intussusception, gastrointestinal bleeding and other gastrointestinal symptoms.

Abdominal pain

Most commonly, about 50% of patients with small intestine adenoma may have different degrees of abdominal pain. The pain is mostly in the mid-abdomen or umbilical circumference. Most patients often have intermittent pain, which is aggravated, with dull pain, dull pain, pain and even Colic, pain often occurs after eating, often relieve or reduce by itself, not heavy at the beginning, with the course of the disease, often accompanied by bowel, abdominal pain due to tumor caused by intestinal dysfunction, tumor surface necrosis caused by inflammatory reaction , ulcer, small intussusception, small intestine obstruction or complete obstruction, of which the most common intussusception, adenoma grows into the cavity, can with the peristalsis and intestinal contents to the distal intestinal fistula, causing the intestine The fold is characterized by repeated episodes of intestinal obstruction and can be relieved by itself. Some patients have acute exacerbations of abdominal pain. Emergency surgery is often needed to relieve obstruction, but most of them have similar episodes of abdominal pain in the past. It is a minority, abdominal pain is often difficult to attract attention in the early stage of the disease, easily misdiagnosed as intestinal fistula, intestinal ascariasis, etc., sometimes even misdiagnosed for several years.

2. Gastrointestinal bleeding

It is also quite common. About 1/4 of patients with small intestine adenoma may have gastrointestinal bleeding, and the tumor expands to a certain volume. The tumor rupture causes the blood vessels on the surface of the tumor to collapse and cause bleeding. Most patients have small bleeding, which is intermittent. Sexual black stools or only fecal occult blood positive, severe bleeding is rare, long-term chronic blood loss, often varying degrees of anemia, patients with pale or sallow, thin, other patients can show acute gastrointestinal bleeding, dark red or It is bright red, sometimes it can be repeated, and it is often necessary for emergency surgery due to severe bleeding.

3. Other

There are abdominal discomfort, belching, nausea and vomiting, weight loss, bloating and even diarrhea. The adenoma of the duodenal papilla may cause obstructive jaundice due to compression or obstruction of the lower end of the common bile duct.

4. Signs

Generally no obvious positive signs, long-term recessive bleeding may have anemia, PJS patients can see lip mucosa, buccal mucosa, gums, palmar and other black plaques, intestinal obstruction may have abdominal bulging, bowel sounds Paroxysmal hyperthyroidism or suffocation of air, can be seen in the intussusception of elliptical masses, especially in the case of abdominal pain in the intestinal tract.

Examination of small intestine adenoma

Histopathological examination is the main basis for the diagnosis of this disease. The tubular adenoma is polypoid, single or multiple. Multiple tumors can be concentrated in one part of the intestine or all small intestines. There are pedicles or pedicles, and the size is different. Mainly the glandular tissue covered by single-layer columnar epithelium, the size of the gland is inconsistent, the shape is irregular, the epithelium is mildly atypical, the mitosis is occasionally seen, and the volume of the villus adenoma is often larger, showing the nipple. Shaped or villous, microscopic examination, mainly by the villous structure, the villus surface covered with more mature single-layer columnar epithelial cells.

X-ray inspection

The diagnostic rate of routine digestive tract barium meal examination is only about 20%. The main reasons are two: 1 small intestine peristalsis is faster, tincture may not be found beyond the diseased intestine; 2 small intestine is long and the disk is folded, and the filling is not continuous. Oral administration of a large amount of tincture may cause image overlap and cover up the lesion. The use of small intestine perfusion examination can increase the diagnostic coincidence rate to 80% to 90%. The specific method is to inject the small intestine catheter through the mouth and place it in the proximal end of the jejunum. Dilution and gas make the whole small intestine form a double contrast, and the catheter can be gradually advanced to the distal side, and the small intestine is examined step by step. X-ray images include: filling defect, disappearance of mucosal pattern, shadowing and narrowing of intestinal lumen, etc. It can also display signs of intussusception and multiple segmental lesions.

2. Fiber endoscopy

For duodenal adenoma, the enteroscopy is helpful for the diagnosis of the upper jejunal adenoma. The fiberoptic colonoscopy can be sent to the ileum 20 to 30 cm through the ileocecal valve, which is helpful for the diagnosis of the terminal ileal adenoma.

3. Selective superior mesenteric artery angiography

It is of great significance for the qualitative and local diagnosis of gastrointestinal bleeding. It can show the size of the tumor. The blood vessels in the adenoma are well-arranged and arranged. The tumor staining is regular and the boundary is clear.

4. Exploratory laparotomy

For patients who cannot be diagnosed and suspected to be small intestine tumors, they should be promptly exploratory laparotomy. Surgical exploration should not miss small adenomatous polyps. If no lesions are found in the diagnosis and percussion, you can use strong light transillumination and cut if necessary. Intraoperative endoscopy in the small intestine, direct observation of the small intestine mucosa, and attention to the possibility of multiple epithelial adenoma.

Diagnosis and diagnosis of small intestine adenoma

diagnosis

The diagnosis of small intestine adenoma is difficult, and the rate of clinical misdiagnosis can reach 65%-80%. The key to diagnosis is that clinicians should be highly vigilant about this disease, and cannot be satisfied with symptom diagnosis and symptomatic treatment. For small intestines with unknown causes Obstruction or recurrent incomplete small bowel obstruction, and may exclude postoperative intestinal adhesion, abdominal wall incarceration, etc.; there are unexplained gastrointestinal bleeding or anemia manifestations to exclude the stomach, colon lesions should consider the possibility of small bowel tumors Sex, if necessary, do targeted examination to reduce misdiagnosis and mistreatment, skin mucous membrane dark spots and can track the history of abdominal pain and family history can diagnose PJS.

Diagnose based on

1. Clinical manifestations.

2. Laboratory and other auxiliary inspections.

3. Exploratory laparotomy:

For patients who cannot be diagnosed and suspected to be small intestine tumors, they should be promptly exploratory laparotomy. Surgical exploration should not miss small adenomatous polyps. If no lesions are found in the diagnosis and percussion, you can use strong light transillumination and cut if necessary. Intraoperative endoscopy in the small intestine, direct observation of the small intestine mucosa, and attention to the possibility of multiple epithelial adenoma.

Differential diagnosis

Duodenal ulcer

Can also have abdominal pain, gastrointestinal bleeding, nausea, vomiting, abdominal distension and other symptoms, in addition to the above performance can also cause pyloric obstruction symptoms, need to be differentiated from duodenal tumor, by X-ray examination, angiography, duodenoscope The examination of the histological examination is distinguishable and, if necessary, surgical exploration is required to confirm the diagnosis.

Enteral tuberculosis

Intestinal tuberculosis may have abdominal pain, diarrhea or constipation, lumps and other manifestations, sometimes easy to be considered as a tumor, but intestinal tuberculosis is accompanied by fever, night sweats and other tuberculosis toxemia, and often accompanied by extraintestinal tuberculosis, gastrointestinal X-ray Tincture examination showed signs of irritability, filling defects or stenosis in the ileocecal area. There were ulcers, stiffness, and stenosis in the lesions of the colonoscopy. The biopsy revealed typical tuberculosis lesions - cheese-like granuloma, anti-tuberculosis treatment. Effective, can be identified with small intestine tumors.

3. Chronic cholecystitis

Most patients have recurrent episodes of dull pain in the right upper quadrant, pain or discomfort. The pain can also be located in the upper abdomen or even the left upper abdomen. It can radiate or radiate to other parts of the abdomen to the shoulders. Minutes to hours, more than 1 hour after a meal, most patients with pain after getting greasy food or high-fat diet can be aggravated.

Generally no obvious signs, only some cases of gallbladder area may have mild tenderness, snoring pain, but no rebound pain, sometimes swollen gallbladder, gallbladder perforation, there may be peritoneal irritation.

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