Small Intestinal Fibroma

　　1. Etiology

　　Fibroma of the small intestine is a benign tumor originating from the fibrous tissue of the small intestinal wall, composed of fibroblasts and other tissue components, and can be divided into adenofibroma, muscular fibroma, and mucinous fibroma, among others. Most are solitary, with a grayish-white cut surface, visible woven stripes, and tough texture.

　　2. Pathogenesis

　　The typical fibroma consists of collagen fibers and fibroblasts, with its stroma being composed only of blood vessels and some loose connective tissue around them. The fibrous tissue of the tumor forms bundles, interweaving with each other. The fibers contain elongated fibroblasts, with no nuclear division visible. The appearance is nodular, with a capsule formed by connective tissue around the tumor, with clear boundaries. Fibromas grow slowly, forming hard nodules, with a diameter generally not exceeding several centimeters.

　　Fibromas occurring in the wall of the small intestine belong to soft fibromas, with relatively more tumor cells and less fibrous components, arranged loosely, forming polypoid masses, known as polypoid fibromas. These are different from fibromas occurring in the skin, fascia, and other locations, where fibrous components are more abundant and tumor cells fewer, known as hard fibromas.

　　Tumors located beneath the mucosal layer grow into the intestinal lumen, forming polypoid masses, with or without pedicles, often causing intussusception and intestinal obstruction; those growing outside the lumen are located beneath the serosal layer, composed of fibrous connective tissue, and sometimes may undergo mucinous change, growing to a large size. The tumor, due to gravity, can cause intestinal torsion and present with绞窄性肠梗阻. Some cases may develop complications such as intestinal perforation and peritonitis on the basis of acute obstruction.

　　1. Intestinal Obstruction

　　Manifestations include chronic progressive small bowel obstruction or acute complete obstruction, with the former being more common. Intestinal obstruction refers to the obstruction of intestinal contents, commonly referred to as an unpassable intestine. Here, the intestine usually refers to the small intestine (jejunum, ileum) and colon (ascending colon, transverse colon, descending colon, sigmoid colon). Acute intestinal obstruction is one of the most common surgical acute abdominal emergencies, often encountered in the emergency room.

　　2. Gastrointestinal bleeding

　　Insufficient blood supply to the local tumor area leads to erosion and ulceration, causing bleeding. Gastrointestinal bleeding is a common clinical disease, often acute in onset and unclear in diagnosis, posing a threat to the patient's life. Gastrointestinal bleeding is usually divided into upper gastrointestinal bleeding and lower gastrointestinal bleeding. Upper gastrointestinal bleeding refers to bleeding points located above the Treitz ligament.

　　The gastrointestinal tract includes the esophagus, stomach, and duodenum, and the bleeding in these areas. Lower gastrointestinal bleeding refers to bleeding in the gastrointestinal tract below the Treitz ligament, including the small intestine, colon, and rectum.

　　1. Obstruction symptoms

　　Specific manifestations include chronic progressive small intestinal obstruction or acute complete obstruction, with the former being more common. Patients often have intermittent colics, which worsen after eating. When gas and fluid pass through the obstructed area, the pain suddenly decreases or disappears. Such symptoms recur, and the next attack is often more severe than the previous one, showing the characteristics of chronic, intermittent, and progressive worsening. When the course of the disease is long, patients often feel gas moving in the abdomen, and gastric and intestinal patterns or peristaltic waves can be seen. High-pitched bowel sounds can be heard. In the late stage of the disease, the upper intestinal tract above the obstruction expands and contracts weakly, the degree and frequency of pain decrease, while abdominal distension becomes more obvious. Abdominal pain changes to persistent distension, and about 1/4 of the patients may have acute attacks, with symptoms such as abdominal pain, distension, vomiting, and cessation of排气 and defecation.

　　Among the causes of obstruction, intussusception is the most common; secondly, it can be caused by tumor growth, narrowing of the intestinal lumen; tumors growing outward are prone to intestinal torsion, causing绞窄性肠梗阻, with abdominal pain that may be continuous or intermittent and worsen.

　　2. Gastrointestinal bleeding

　　Intramural cavity-type tumors located below the mucosal layer grow into the intestinal lumen, which can flatten the superficial mucosa, cause insufficient local blood supply, leading to erosion, ulceration, and bleeding. Most of the bleeding is positive for occult blood test in feces, and massive bleeding is rare.

　　3. Other

　　There may also be symptoms such as abdominal discomfort, weight loss, poor appetite, and weight loss.

　　4. Signs

　　During intestinal obstruction, there may be varying degrees of abdominal distension, and intestinal patterns and peristaltic waves are often visible. When intussusception occurs, a sausagelike mass can be palpated. When intestinal obstruction is complicated with intestinal perforation, signs of peritonitis appear, and the entire abdomen may have tenderness, rebound pain, and muscle tension.

　　1. Do not drink alcoholic beverages for a long time, quit smoking and drinking habits, do not overeat pickled vegetables, sour, spicy and irritating foods, and prohibit eating moldy foods. It is more important for those with chronic pharyngitis to develop good dietary hygiene habits, such as eating less meat and more vegetables, and eating more fresh fruits and vegetables.

　　2. During the cold season, maintain appropriate temperature and humidity indoors and pay attention to air circulation. A room temperature of 20℃ is ideal. Do not cover yourself with too many quilts during sleep at night to avoid excessive temperature or excessive dryness, which may cause discomfort in the throat. Do not sleep with the wind blowing, and rest for a while after strenuous labor, do not take a cold shower immediately. For those with acute pharyngitis caused by a cold or flu, drink more hot water or ginger soup to induce sweating and increase urination. Pay attention to the smooth defecation. Treat acute inflammation in a timely manner to prevent it from becoming chronic. Organs with chronic lesions are more prone to malignant changes.

　　3. Strengthen labor protection. Proper handling is required for harmful gases, dust, such as silica dust, ammonia chloride, bromine, iodine, and others during the production process. Workers who have long-term contact with harmful chemical gases should wear gas masks and protective isolation clothing, etc.

　　1. X-ray Examination

　　Routine radiographic examination has a low positive rate, and abdominal plain film is convenient for observing the presence of intestinal obstruction, such as the presence of dilated intestinal tract and liquid level, which can roughly estimate the lesion site. Routine barium meal for gastrointestinal tract can be missed due to intestinal loop winding and folding, and a small dose of barium agent can be used for segmented examination in clinical practice; or the small intestinal lavage contrast method can be used by inserting a bag-shaped intestinal decompression tube into the suspected lesion site and injecting contrast medium, which can aspirate intestinal contents for examination of occult blood; or use barium enema for retrograde small intestinal contrast, etc., to improve the diagnostic rate.

　　2. Fiberoptic

　　Endoscopic examination for suspected duodenal lesions uses duodenoscopy, the proximal jejunum can be selected with fiberoptic enteroscopy, and the distal ileum can be used with colonoscopy. Endoscopic examination can directly observe the local lesion and can take a biopsy for confirmation.

　　3. Selective Mesenteric

　　Angiography of the superior mesenteric artery is rare in the bleeding of small intestinal fibroma, but for fibromas with active bleeding complications, emergency angiography is a very valuable diagnostic method, which can show the bleeding site and has important diagnostic value even after the bleeding stops, showing the abnormal blood vessel distribution of the tumor.

　　4. Ultrasound Examination

　　Patients with palpable masses in the abdomen can also undergo ultrasound examination to observe the shape of the tumor and its relationship with the intestinal tract, and ultrasound is also convenient for detecting extracorporeal tumors.

　　Firstly, what foods should small intestinal fibroma eat for the body's health?

　　High-fat diet and low-fiber foods.

　　Secondly, what foods should small intestinal fibroma not eat?

　　1. Avoid strong alcohol, spicy, dry and hot, and刺激性 food.

　　2. Eat less fried, smoked, and salted foods.

　　1. Treatment

　　Small intestinal fibroma is less likely to become malignant, but it often causes serious complications, so once diagnosed, it should be surgically removed. Depending on the size and location of the tumor, local tumor resection or partial resection of the involved intestinal tract and intestinal anastomosis should be performed. If there is no obvious adhesion in the intestinal intussusception and there is no intestinal wall blood supply obstruction after reduction, it can be treated according to the above principles. Do not force the reduction of the intestinal intussusception with adhesions, and the tumor along with the involved intestinal segment can be resected together.

　　2. Prognosis

　　After treatment, small intestinal fibroma has a good prognosis.