Malignant tumors of the small bowel account for less than 10% of all gastrointestinal neoplasms. The majority of these tumors are secondary neoplasms metastatic from either an intra- or extra-abdominal site. Symptoms related to these tumors include bleeding, obstruction, and perforation, although the great majority of these metastases remain asymptomatic and are only discovered at autopsy. Outcomes remain poor and most interventions are palliative. We review the current surgical recommendations for management of this challenging clinical scenario.