Practice Essentials

Benign tumors of the small bowel are rare clinical entities that often remain asymptomatic throughout life.^{[1, 2, 3, 4, 5]}Despite comprising 75% of the length and 90% of the surface area of the gastrointestinal (GI) tract, the small bowel harbors relatively few primary neoplasms and fewer than 2% of GI malignancies.^[6]

Benign small-bowel tumors may develop as a single lesion or as multiple lesions of several subtypes. Subtypes include the following:

Hyperplastic polyps
Hamartomas
Adenomas
Gastrointestinal stromal tumors (GISTs)
Lipomas
Hemangiomas
Those associated with Peutz-Jeghers syndrome ^[7]

A multicenter study from Taiwan found hamartomas and adenomas to be the most common benign small-bowel tumors.^[8]

Benign small-bowel tumors are generally characterized by slow growth and delayed clinical presentation. They often remain inherently asymptomatic, only to be discovered incidentally.^[5]

Strict medical management currently has no role in the treatment of benign small-bowel tumors. Surgical excision remains the recommended therapy for these tumors. (See Treatment.)

Pathophysiology

Benign small-bowel tumors may be found throughout the duodenum, jejunum, and ileum (in order of increasing frequency). Tumors may be single, multiple, or widespread (ie, as part of a polyposis syndrome). The following three growth patterns have been identified:

Intraluminal
Infiltrative
Serosal

Intraluminal lesions are most often associated with the development of secondary bowel obstruction and intussusception, whereas serosal lesions are linked to small-bowel volvulus.

Several factors have been suggested to explain both the scarcity of small-bowel lesions and the infrequency of their malignant transformation, as follows^[9]:

First, rapid intestinal transit through the small bowel limits contact time to the small-bowel mucosa
Second, greater fluidity of small-bowel chyme may dilute luminal irritants
Third, alkaline pH may play a role, as may the low bacterial colony counts of the small bowel
Finally, higher levels of benzyl peroxidase (thought to detoxify potential carcinogens) have been detected in the small bowel

Together, with increased levels of immunoglobulin A and widespread gut lymphoid tissue, these factors may impede the growth and development of tumors and their malignant transformation.

Epidemiology

Benign small-bowel lesions have been documented in persons of all age groups, though the mean age of presentation has been reported to be between the fifth and sixth decades of life. Several series have noted a slight predominance in males as compared with females. No racial or ethnic predisposition has been discovered.

Clinical Presentation

Pourmand K, Itzkowitz SH. Small Bowel Neoplasms and Polyps. Curr Gastroenterol Rep. 2016 May. 18 (5):23. [QxMD MEDLINE Link].
Tsuruta K, Takedatsu H, Yoshioka S, Yoshikai M, Tomiyasu K, Morita M, et al. Symptoms Contributing to the Diagnosis of Small Bowel Tumors. Digestion. 2023 Jul 12. 1-8. [QxMD MEDLINE Link].
Blanchard DK, Budde JM, Hatch GF 3rd, Wertheimer-Hatch L, Hatch KF, Davis GB, et al. Tumors of the small intestine. World J Surg. 2000 Apr. 24 (4):421-9. [QxMD MEDLINE Link].
Minardi AJ Jr, Zibari GB, Aultman DF, McMillan RW, McDonald JC. Small-bowel tumors. J Am Coll Surg. 1998 Jun. 186 (6):664-8. [QxMD MEDLINE Link].
Jasti R, Carucci LR. Small Bowel Neoplasms: A Pictorial Review. Radiographics. 2020 Jul-Aug. 40 (4):1020-1038. [QxMD MEDLINE Link]. [Full Text].
Zollinger RM Jr. Primary neoplasms of the small intestine. Am J Surg. 1986 Jun. 151 (6):654-8. [QxMD MEDLINE Link].
McGarrity TJ, Kulin HE, Zaino RJ. Peutz-Jeghers syndrome. Am J Gastroenterol. 2000 Mar. 95 (3):596-604. [QxMD MEDLINE Link].
Chung CS, Tai CM, Huang TY, Chang CW, Chen KC, Tseng CM, et al. Small bowel tumors: A digestive endoscopy society of Taiwan (DEST) multicenter enteroscopy-based epidemiologic study. J Formos Med Assoc. 2018 Aug. 117 (8):705-710. [QxMD MEDLINE Link]. [Full Text].
Genta RM, Feagins LA. Advanced precancerous lesions in the small bowel mucosa. Best Pract Res Clin Gastroenterol. 2013 Apr. 27 (2):225-33. [QxMD MEDLINE Link].
Sorleto M, Timmer-Stranghöner A, Wuttig H, Engelhard O, Gartung C. Brunner's Gland Adenoma - A Rare Cause of Gastrointestinal Bleeding: Case Report and Systematic Review. Case Rep Gastroenterol. 2017 Jan-Apr. 11 (1):1-8. [QxMD MEDLINE Link]. [Full Text].
Merine D, Jones B, Ghahremani GG, Hamilton SR, Bayless TM. Hyperplasia of Brunner glands: the spectrum of its radiographic manifestations. Gastrointest Radiol. 1991 Spring. 16 (2):104-8. [QxMD MEDLINE Link].
Rüfenacht H, Kasper M, Heitz PU, Streule K, Harder F. "Brunneroma": hamartoma or tumor?. Pathol Res Pract. 1986 Mar. 181 (1):107-11. [QxMD MEDLINE Link].
Bremer EH, Battaile WG, Bulle PH. Villous tumors of the upper gastrointestinal tract. Clinical review and report of a case. Am J Gastroenterol. 1968 Aug. 50 (2):135-43. [QxMD MEDLINE Link].
Ludwig DJ, Traverso LW. Gut stromal tumors and their clinical behavior. Am J Surg. 1997 May. 173 (5):390-4. [QxMD MEDLINE Link].
He LJ, Wang BS, Chen CC. Smooth muscle tumours of the digestive tract: report of 160 cases. Br J Surg. 1988 Feb. 75 (2):184-6. [QxMD MEDLINE Link].
Morgan BK, Compton C, Talbert M, Gallagher WJ, Wood WC. Benign smooth muscle tumors of the gastrointestinal tract. A 24-year experience. Ann Surg. 1990 Jan. 211 (1):63-6. [QxMD MEDLINE Link].
Amin MB, Ma CK, Linden MD, Kubus JJ, Zarbo RJ. Prognostic value of proliferating cell nuclear antigen index in gastric stromal tumors. Correlation with mitotic count and clinical outcome. Am J Clin Pathol. 1993 Oct. 100 (4):428-32. [QxMD MEDLINE Link].
Nincheri Kunz M, Evaristi L, Spadoni R, Cozzani R, Valle O, Bacigalupo B. [Lipoma of the small intestine as a rare cause of intestinal occlusion]. Minerva Chir. 1994 Sep. 49 (9):859-65. [QxMD MEDLINE Link].
Kim YS, Chun HJ, Jeen YT, Um SH, Kim CD, Hyun JH. Small bowel capillary hemangioma. Gastrointest Endosc. 2004 Oct. 60 (4):599. [QxMD MEDLINE Link].
Ramanujam PS, Venkatesh KS, Bettinger L, Hayashi JT, Rothman MC, Fietz MJ. Hemangioma of the small intestine: case report and literature review. Am J Gastroenterol. 1995 Nov. 90 (11):2063-4. [QxMD MEDLINE Link].
Boyle L, Lack EE. Solitary cavernous hemangioma of small intestine. Case report and literature review. Arch Pathol Lab Med. 1993 Sep. 117 (9):939-41. [QxMD MEDLINE Link].
Drolet BA, Pope E, Juern AM, Sato T, Howell B, Puttgen KB, et al. Gastrointestinal bleeding in infantile hemangioma: a complication of segmental, rather than multifocal, infantile hemangiomas. J Pediatr. 2012 Jun. 160 (6):1021-6.e3. [QxMD MEDLINE Link].
Barkay O, Moshkowitz M, Fireman Z, Shemesh E, Goldray O, Revivo M, et al. Initial experience of videocapsule endoscopy for diagnosing small-bowel tumors in patients with GI polyposis syndromes. Gastrointest Endosc. 2005 Sep. 62 (3):448-52. [QxMD MEDLINE Link].
Ziegler KM, Flamm CR, Aronson N. Wireless capsule endoscopy in patients with obscure small-intestinal bleeding. J Am Coll Radiol. 2005 Oct. 2 (10):818-20. [QxMD MEDLINE Link].
Wang H, Luo T, Liu WQ, Huang Y, Wu XT, Wang XJ. Clinical presentations and surgical approach of acute intussusception caused by Peutz-Jeghers syndrome in adults. J Gastrointest Surg. 2011 Dec. 15 (12):2218-25. [QxMD MEDLINE Link].
Cochet B, Carrel J, Desbaillets L, Widgren S. Peutz-Jeghers syndrome associated with gastrointestinal carcinoma. Report of two cases in a family. Gut. 1979 Feb. 20 (2):169-75. [QxMD MEDLINE Link].
Perko Z, Krnić D, Pogorelić Z, Druzijanić N, Simunić M, Bilan K, et al. Peutz-Jeghers syndrome complicated with intussusception: enteroscopic polyps resections through laparotomy. Coll Antropol. 2013 Mar. 37 (1):293-6. [QxMD MEDLINE Link].
Latchford AR, Neale K, Phillips RK, Clark SK. Peutz-Jeghers syndrome: intriguing suggestion of gastrointestinal cancer prevention from surveillance. Dis Colon Rectum. 2011 Dec. 54 (12):1547-51. [QxMD MEDLINE Link].
Metzger PP, Slappy AL, Chua HK. Ileal lipoma. Surg Rounds. 2005. 28(2):84-6.
Minordi LM, Binda C, Scaldaferri F, Holleran G, Larosa L, Belmonte G, et al. Primary neoplasms of the small bowel at CT: a pictorial essay for the clinician. Eur Rev Med Pharmacol Sci. 2018 Feb. 22 (3):598-608. [QxMD MEDLINE Link]. [Full Text].
Iadicola D, De Marco P, Bonventre S, Grutta EM, Barletta G, Licari L, et al. Bowel wall thickening: inquire or not inquire? Our guidelines. G Chir. 2018 Jan-Feb. 39 (1):41-44. [QxMD MEDLINE Link]. [Full Text].
Fujita M, Manabe N, Honda K, Murao T, Osawa M, Kawai R, et al. Usefulness of Ultrasonography for Diagnosis of Small Bowel Tumors: A Comparison Between Ultrasonography and Endoscopic Modalities. Medicine (Baltimore). 2015 Oct. 94 (40):e1464. [QxMD MEDLINE Link].
Maccioni F, Busato L, Valenti A, Cardaccio S, Longhi A, Catalano C. Magnetic Resonance Imaging of the Gastrointestinal Tract: Current Role, Recent Advancements and Future Prospectives. Diagnostics (Basel). 2023 Jul 19. 13 (14):[QxMD MEDLINE Link]. [Full Text].
Pal P, Tandan M, Kulkarni S, Reddy PM, Ramchandani M, Sekaran A, et al. Is intraoperative enteroscopy still relevant in small bowel disorders in the era of capsule endoscopy and device-assisted enteroscopy? Real-world experience from a tertiary care hospital. J Gastroenterol Hepatol. 2021 Nov. 36 (11):3183-3190. [QxMD MEDLINE Link].
Moyón FX, Molina GA, Romero K, Moyón MA, Cardenas BA, Tufiño J, et al. Laparoscopy and intraoperative enteroscopy, a helpful tool in a rare tumor (inflammatory fibroid polyp) of the small bowel. A case report. Ann Med Surg (Lond). 2021 Jun. 66:102355. [QxMD MEDLINE Link]. [Full Text].
Takano Y, Niiya F, Nagahama M. Transgastric endoscopic ultrasound-guided fine needle biopsy for diagnosing gastrointestinal stromal tumor of the jejunum. Dig Endosc. 2023 Sep. 35 (6):e117-e118. [QxMD MEDLINE Link].
Karargyris A, Bourbakis N. Detection of small bowel polyps and ulcers in wireless capsule endoscopy videos. IEEE Trans Biomed Eng. 2011 Oct. 58 (10):2777-86. [QxMD MEDLINE Link].
Rana SS, Bhasin DK, Singh K. Colonic lesions in patients undergoing small bowel capsule endoscopy. Int J Colorectal Dis. 2011 Jun. 26 (6):699-702. [QxMD MEDLINE Link].
Kopylov U, Seidman EG. Diagnostic modalities for the evaluation of small bowel disorders. Curr Opin Gastroenterol. 2015 Mar. 31 (2):111-7. [QxMD MEDLINE Link].
Calabrese C, Gionchetti P, Calafiore A, Pagano N, Campieri M, Rizzello F. Sporadic small bowel tumors detected by capsule endoscopy in patients with occult gastrointestinal bleeding. Intern Emerg Med. 2015 Oct. 10 (7):781-5. [QxMD MEDLINE Link].
Lamps LW. Small bowel. Goldblum JR, Lamps LW, McKenney JK, Myers JL, eds. Rosai and Ackerman's Surgical Pathology. 11th ed. Philadelphia: Elsevier; 2018. Vol 1: 568-616.
Toya Y, Endo M, Orikasa S, Sugai T, Matsumoto T. Lipoma of the small intestine treated with endoscopic resection. Clin J Gastroenterol. 2014 Dec. 7 (6):502-5. [QxMD MEDLINE Link].
Lee CM, Kim HH. Minimally invasive surgery for submucosal (subepithelial) tumors of the stomach. World J Gastroenterol. 2014 Sep 28. 20 (36):13035-43. [QxMD MEDLINE Link].
Bedirli A, Salman B, Nasirov M, Dogan I. A Novel Technique for Duodenal Resection and Primary Anastomosis With Robotic Assistance and OrVil. JSLS. 2017 Jan-Mar. 21 (1):[QxMD MEDLINE Link]. [Full Text].
Zou Q, Feng L, Ouyang M. [Option for different surgeries in treating small gastrointestinal stromal tumors]. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2018 Jul 28. 43 (7):767-771. [QxMD MEDLINE Link].
Wang ZZ, Zhou XB, Wang Y, Mao XL, Ye LP, Yan LL, et al. Effectiveness and safety of over-the-scope clip in closing perforations after duodenal surgery. World J Gastroenterol. 2021 Sep 21. 27 (35):5958-5966. [QxMD MEDLINE Link]. [Full Text].
Glosser LD, Lombardi CV, Knauss HM, Hopper W, Alalwan A, Stanek S. Treatment of duodenal lipoma with robotic-assisted transverse duodenotomy: A case report of novel approach. Int J Surg Case Rep. 2021 Sep. 86:106366. [QxMD MEDLINE Link]. [Full Text].
Cho HJ, Jang JY, Jeong SY, Kang IC, Lee SH, Choi SH. Robotic limited local resection of duodenal juxta-ampullary neoplasms. Int J Med Robot. 2021 Apr. 17 (2):e2192. [QxMD MEDLINE Link].
Tang SJ, Zanati S, Dubcenco E, Christodoulou D, Cirocco M, Kandel G, et al. Capsule endoscopy regional transit abnormality: a sign of underlying small bowel pathology. Gastrointest Endosc. 2003 Oct. 58 (4):598-602. [QxMD MEDLINE Link].

Media Gallery

Benign neoplasm of the small intestine. Arteriogram demonstrating small bowel gut stromal tumor, indicated by round tumor blush in lower right corner of the image.
Benign neoplasm of the small intestine. Intraoperative view of an ependymal small bowel stromal tumor. Notice the narrow lesion stalk and high degree of vascularity.
Benign neoplasm of the small intestine. Cross section of a gross ependymal small bowel stromal tumor after removal. Mixed stromal elements and a high degree of cellularity are apparent.

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Sections Benign Neoplasms of the Small Intestine
Overview
Presentation
DDx
Workup
Treatment
Media Gallery
References

Benign Neoplasms of the Small Intestine

Practice Essentials

Pathophysiology

Epidemiology

References

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