Small bowel tumors: a continuing challenge.

Small bowel tumors are difficult to diagnose and are frequently not identified at initial evaluation. We retrospectively reviewed 25 consecutive cases to assess the efficacy of procedures currently used in diagnosis. Barium contrast studies were diagnostic in 14 (56%) of the cases. Enteroclysis provided one diagnosis after the initial barium study was negative. Of the 11 patients for whom barium studies were negative, angiography provided the diagnosis in six (three benign, three malignant). Endoscopy was never helpful. Laparotomy was required in five cases (three benign, two malignant) after repeated negative work-ups. An evaluation protocol which calls for each method as needed seems to provide the most reliable means of diagnosing small bowel tumors.