Vanek’s tumor of the small bowel in adults

Abstract

Inflammatory fibroid polyps (IFPs), or Vanek’s tumor, are one of the least common benign small bowel tumors. IFP affects both sexes and all age groups, with a peak of incidence in the fifth and seventh decades. They can be found throughout the gastrointestinal tract but most commonly in the gastric antrum or ileum. The underlying cause of IFPs is still unknown. Genetic study of IFP showed mutations in platelet derived growth factor alpha in some cases. At the time of diagnosis most IFPs have a diameter of 3 to 4 cm. The lesions have always been recorded as solitary polyps. Symptoms depend on the location and the size of the lesion, including abdominal pain, vomiting, altered small bowel movements, gastrointestinal bleeding and loss of weight. IFPs arising below the Treitz ligament can present with an acute abdomen, usually due to intussusceptions. Abdominal computed tomography is currently considered the most sensitive radiological method to show the polyp or to confirm intussusceptions. Most inflammatory fibroid polyps can be removed by endoscopy. Surgery is rarely needed. Exploratory laparoscopy or laparotomy is frequently recommended as the best treatment for intussusceptions caused by IFP. The operation should be performed as early as possible in order to prevent the intussusceptions from leading to ischemia, necrosis and subsequent perforation of the invaginated bowel segment. This report aims at reviewing the diagnosis, etiology, genetics, clinical presentation, endoscopy, radiology, and best treatment of IFP.

Keywords: Small bowel, Inflammatory fibroid polyps, Abdominal pain, Intussusception, Computed tomography scan, Surgery

Core tip: Inflammatory fibroid polyps, or Vanek’s tumor, are one of the least common benign small bowel tumors. Abdominal computed tomography is currently considered the most sensitive radiological method to show the polyp or to confirm complications. This report aims at reviewing the etiology, diagnosis, and treatment options of this entity, with emphasis on the success rate of radiologic investigations, the need for laparoscopic diagnosis and the role of surgery. The debate arises over the importance of the differential diagnosis. Moreover, if surgery is performed, consideration needs to be given to what operation should be undertaken and in which patients.