Smooth muscle sarcoma of the small intestine

　　The etiology of smooth muscle sarcoma of the small intestine is not yet clear. It originates from the smooth muscle tissue of the small intestinal wall, which is mostly round or lobulated, with clear boundaries and expansive growth, and a low infiltration rate into surrounding tissues. During the growth process, part of the smooth muscle sarcoma can protrude into the intestinal lumen, but most of the tumors protrude outward to form larger masses, or protrude inward and outward, forming a dumbbell shape.

　　Intussusception, intestinal necrosis, anemia, and other complications are common in this disease. When the tumor grows to a certain degree, it can make the intestinal lumen smaller, causing incomplete or complete intestinal obstruction. Chronic and long-term blood loss can cause anemia.

　　Early stage smooth muscle sarcoma of the small intestine is often asymptomatic due to a small tumor size and no ulceration. Symptoms appear when the tumor grows to a certain volume or bleeding occurs. Specific symptoms include the following:

　　1. Abdominal pain

　　More than half of the patients have abdominal pain, but the location and nature are non-specific, mostly presenting as dull or aching pain. Abdominal pain has no obvious regularity.

　　2. Intestinal obstruction

　　When the tumor grows to a certain degree, it can make the intestinal lumen smaller, causing incomplete or complete intestinal obstruction. The intraluminal type of sarcoma, with the peristalsis of the intestine and the movement of intestinal contents towards the distal side, forms an intussusception, presenting with symptoms of incomplete intestinal obstruction, which can be self-resolved or recurrent呈 intermittent. Smooth muscle sarcomas are more common in the extraluminal type, and they are larger in size, which are prone to cause intestinal torsion, leading to绞窄性肠梗阻. Patients may present with persistent abdominal pain, distension, vomiting, no anal exhaust and defecation, and other symptoms.

　　3. Gastrointestinal bleeding

　　Gastrointestinal bleeding is relatively common, most of which are positive for occult blood in stool or intermittent black stool. Duodenal and proximal jejunum smooth muscle sarcomas can cause hematemesis.

　　4. Abdominal mass

　　Half of the patients present abdominal mass as the initial symptom, with extraluminal type being more common.

　　Smooth muscle sarcoma of the small intestine should refer to the general prevention methods of tumors in the prevention. Attention should be paid to keeping away from harmful factors such as radiation and to strengthening physical exercise, maintaining a pleasant mood, and developing good living habits.

　　The auxiliary examination methods for small intestinal leiomyosarcoma mainly include the following:

　　1. X-ray examination

　　Routine radiographic examination has a low positive rate. Abdominal plain film is convenient for observing the presence of intestinal obstruction. Clinically, a segmental examination method with a small dose of barium can be adopted, or the small bowel enema with contrast medium can be performed by inserting a bag-like small bowel decompression tube into the suspected lesion site, or the retrograde small bowel contrast examination method using barium enema can be adopted, etc., to improve the diagnostic rate.

　　2. Fiberoptic endoscopic examination

　　For suspected duodenal lesions, duodenoscopy should be used; the proximal jejunum can be chosen with fiberoptic small bowel endoscopy; the distal ileum can be used with a colonoscope, and biopsy can be taken for diagnosis.

　　3. Selective superior mesenteric artery angiography

　　Selective mesenteric angiography can display the tumor vascular shadow, and the tumor boundary is usually clear.

　　4. Ultrasound or CT, MRI examination

　　Ultrasound examination can observe the shape of the tumor and its relationship with the intestinal tract, and it is also convenient to detect extraintestinal type tumors. CT or MRI examination is helpful to observe the location, size, and relationship with surrounding organs of the tumor.

　　Patients with small intestinal leiomyosarcoma should pay attention to light diet, ensure adequate nutrition. Eat more fresh fruits and vegetables, and eat more foods that can improve immunity to enhance the body's immunity. In addition, patients should avoid smoking and drinking, and avoid spicy, greasy, and cold foods.

　　The treatment of small intestinal leiomyosarcoma still mainly relies on surgical resection, and frozen section should be performed during the operation. Generally, it is advisable to resect the local intestinal segment. Tumors usually do not metastasize to lymph nodes, so it is not necessary to perform lymph node dissection; only a扇形resection of the related omentum is required. If the tumor has adhered to surrounding organs or tissues, it should not be forcibly separated, and the organs or tissues connected to it should be resected simultaneously. Sometimes, if the base of the tumor is close to the inner wall of the duodenum or it is difficult to separate from the pancreas, a pancreatectomy with duodenectomy can be performed. For recurrent smooth muscle tumors after surgery, liver metastasis will eventually occur. For a single metastatic focus, local wedge resection can be performed. For multiple metastatic foci concentrated in one place, a partial liver resection can be performed. For scattered multiple nodules, selective hepatic artery catheter embolization and chemotherapy can be performed.