Small intestinal leiomyomas

　　Small intestinal leiomyomas occur in the muscular layer or submucosal muscular layer of the intestinal wall, and some originate from the muscular layer of blood vessels. Tumors are usually solitary, of varying sizes, often round or elliptical, and sometimes lobulated or nodular. The texture of the tumor is relatively tough, with a clear boundary, and the cut surface is pale gray-red, with visible woven fiber bundles.

　　The main complications of small intestinal leiomyomas mainly include the following two types:

　　1, Internal fistula

　　Internal fistula is a common complication of extracorporeal leiomyomas, often caused by ischemia, necrosis, infection, or cystic change of the center of the leiomyoma, leading to perforation of the intestinal lumen. Patients may have symptoms such as abdominal pain and fever.

　　2, Peritonitis

　　The tumor can break through into the abdominal cavity, causing peritonitis.

　　Small intestinal leiomyomas in the early stage often have small tumors without ulcers and are asymptomatic. Symptoms appear when the tumor grows to a certain size or bleeds. Patients may have symptoms such as abdominal pain, bloating, abdominal mass, and gastrointestinal bleeding, and may also have symptoms such as anemia, weight loss, fatigue, decreased appetite, and fever. The specific manifestations are as follows:

　　1, Gastrointestinal bleeding

　　About half of the patients have gastrointestinal bleeding symptoms. Some patients may present with anemia of unknown cause, while others may manifest as acute gastrointestinal bleeding. Patients may have black stools or tarry stools. After the mucosal lesion heals, bleeding may stop, but it can recur.

　　2, Abdominal pain

　　Abdominal pain is common, and it can present as intermittent, dull pain, gradually becoming sharp or colicky pain. The pain is often located in the middle abdomen or around the umbilicus, and it can also appear in the upper left quadrant and lower left quadrant of the abdomen. It is often accompanied by symptoms such as loss of appetite, fatigue, and diarrhea.

　　3, Abdominal mass

　　Approximately one-fourth of patients can feel an abdominal mass clinically. Due to the anatomical characteristics of the small intestine itself, the abdominal mass is not easy to detect in the early stage, and it can only be felt when the mass grows to a larger size. The mass often has a large degree of mobility, can be pushed in the vertical direction of the root of the mesentery, and some can even migrate to the entire abdominal cavity.

　　4. Intestinal obstruction

　　Intestinal obstruction is a major manifestation of intraluminal tumors, and symptoms usually appear early. It is generally chronic incomplete intestinal obstruction, mainly manifested as persistent abdominal dull pain and discomfort, and exacerbation in attacks.

　　When preventing jejunal smooth muscle tumors, it should be referred to the general prevention methods for tumors. During prevention, attention should be paid to staying away from dangerous factors such as radiation, strengthening physical exercise, maintaining a pleasant mood, and developing good living habits.

　　The main examination methods for jejunal smooth muscle tumors are as follows:

　　1. Endoscopic examination

　　Gastrointestinal stromal tumors are most common in the jejunum. The proximal jejunum can be examined by enteroscopy, and biopsy can be performed to clarify the diagnosis; the distal ileum can be examined by colonoscopy.

　　2. Selective mesenteric angiography

　　Performing mesenteric angiography for unexplained gastrointestinal bleeding can locate the bleeding site and has certain significance for early diagnosis of the disease.

　　3. Radioisotope scanning

　　The 99mTc imaging method has a high detection rate for gastrointestinal bleeding. Even when the bleeding rate is only 0.05-0.1ml/min, radioactive nuclides can be detected from the blood vessels into the intestinal lumen, but this method has poor localization accuracy.

　　4. Laparoscopic examination

　　Laparoscopy can directly observe abdominal masses, perform pathological biopsy, and is of certain value for the diagnosis of this disease.

　　In terms of diet, jejunal smooth muscle tumor patients should pay attention to food diversity, ensure balanced nutrition. Eat more iron, calcium, and vitamin C-rich foods. In addition, patients should avoid smoking and drinking, and avoid spicy, greasy, and cold foods.

　　Gastrointestinal stromal tumors have a malignant transformation rate of 15% to 20%, so they should be surgically removed actively once detected. During the operation, attention should be paid to the differentiation of benign and malignant tumors, and routine frozen section examination should be performed to clarify the diagnosis. For those who are difficult to distinguish between benign and malignant, it is advisable to treat them as sarcomas. Intestinal partial resection and anastomosis can be performed for jejunal smooth muscle tumors; duodenal smooth muscle tumors should be wedge resection, duodenal partial resection, or pancreaticoduodenectomy according to the location of the tumor.