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The records of 43 patients with 32 malignant and 11 benign neoplasms of the small intestine were reviewed in order to improve early diagnosis. The malignant tumours comprised of 14 carcinoids, 10 carcinomas and 8 sarcomas. The benign tumours constituted 7 different histological types. An increasing frequency of malignant tumours through the bowel was found. Thirty-three per cent of all patients had a sudden onset of symptoms leading to acute explorative laparotomy, whereas the remaining 67 per cent were characterized by a long history. The predominant symptoms were abdominal pain, nausea and vomiting, weight loss and a palpable abdominal mass. An exact preoperative diagnosis was made in 41 per cent of the cases. Upper gastrointestinal X-ray contrast examination with small bowel follow through and ultrasonography gave the greatest sensitivity. A diagnostic strategy was difficult to recommend considering the rarity of these tumours and the low sensitivity of the employed diagnostic modalities. Recently developed Japanese enteroscopes capable of exploring the entire small bowel seem to offer the most promising diagnostic method for the future.

We present a patient who had a left mastectomy for breast cancer and 3 years later developed intestinal obstruction due to metastatic spread to the small bowel. The small bowel follow through showed multiple stenoses of the small intestine leading to a variety of differential diagnostic considerations as metastatic spread from breast cancer to the small intestine has not been convincingly documented so far.

A collected series from the English literature up to 1984 of spontaneous clostridial myonecrosis (SCM) is presented in order to reveal possible common denominators. SCM was associated with malignancy (colonic cancer and leukaemia), diabetes, and injections in descending order. C. perfringens was isolated in more than 70% of the cases followed by C. septicum in 27 and C. novyi in 7%. The pathogenesis is still speculative but is thought to be due to bacteraemia especially from the gastrointestinal tract, due to growth of dormant spores in tissue following antecedent trauma or as an infection descending along the ilio-psoas sheath from a gastrointestinal focus. The symptoms are pain in an oedematous, discoloured, crepitant area with haemorhagic bullae and often shock. The diagnosis is based on the clinical findings and Gram-positive rods in the exudate. Treatment instituted promptly constitutes of surgical debridement, antibiotics and hyperbaric oxygen. The prognosis of SCM is worse than for other cases of clostridial myonecrosis and survival was in this collected series only 19%.

This article presents a review of the literature concerning the employment of tissue adhesives in the production of intestinal anastomoses. The fibrin adhesive is the tissue adhesive of choice in as much as it is physiological does not possess histotoxicity or cause allergic reactions. Fibrin adhesive sealing of a conventional sutured anastomosis might improve this anastomosis as it reduced the postoperative mortality-rate significantly in a prospective study with a retrospectively matched control group comparing sealing and no sealing, but prospective, randomized trials are lacking. Finally a cyanoacrylate intestinal anastomosis has proved obsolete as in experimental trials it has proved inferior to the conventional anastomosis.