The overall survival from primary malignancies of the small intestine has not changed over more than four decades. This generally is ascribed to delays in establishing the diagnosis and the advanced stage of the disease when treatment is begun. There has been no critical analysis of these delays. To answer these questions, we reviewed the records of all patients diagnosed with small bowel malignancy from 1967 to 1988 at the Methodist Hospital of Indiana. The onset and duration of symptoms, first medical consultation, time of performance of diagnostic procedures and surgery were verified in 77 patients with histologically confirmed small bowel malignancies. The longest delay occurs from the time medical help is sought to the time the diagnosis is made, not from the onset of symptoms to the first medical consultation. The small bowel should always be considered as a source of unexplained, persistent subtle abdominal symptoms.