Although the tendency for smooth muscle tumors of the gastrointestinal tract to bleed massively is well known, certain features deserve reemphasis. Benign tumors as small as 2 cm. in diameter are sometimes associated with repeated episodes of exsanguinating hemorrhage over a period of months or years. Rarely, fatal gastrointestinal hemorrhage occurs and the diagnosis is made only at the autopsy table.1,3 A confusing clinical picture results when these repeatedly bleeding leiomyomas are otherwise asymptomatic, cannot be demonstrated by x-ray, and are not palpable through the abdominal wall. Frequently, hemorrhage stops spontaneously after hospitalization, bed rest, and transfusions. In these cases the diagnosis is often mistaken for recurrently bleeding peptic ulcer. Many such patients have been treated with a medical peptic ulcer regimen for long periods prior to correct diagnosis. Between acute episodes of bleeding, patients may be apparently healthy and have no anemia or occult blood loss. Report of CasesCase 1.\p=m-\This 65-year-old dietitian was admitted to Duke University Hospital, Durham, N.C., in March, 1954, because of anemia which had de¬ veloped rapidly during the preceding 10 days.There was a past history of a precipitous drop in hemoglobin over a period of a few days on three occasions during the previous two years.She had never observed her stools and therefore a history of melena had not been obtained. Her physician administered blood transfusions on each occasion, and her hemoglobin returned to normal levels where it remained for a number of weeks or months until the next "attack." Barium x-ray studies of the stomach, duodenum, and the colon had been negative four months prior to admission.Physical examination on admission was negative except for pallor, restlessness, a cool moist skin, and tachycardia. There were no abdominal masses. Rectal examination revealed a large quantity of tarry stool which gave a 4+ reaction to guaiac solution. Admission hemoglobin was 5.6 gm. ; hematocrit, 18%. She received whole blood trans¬ fusions and was placed on a modified ulcer regi¬ men. Stools remained tarry. A repeat bariumx-ray examination of her esophagus, stomach, duodenum, small bowel, and colon was again within normal limits. On the ninth hospital day an exploratory laparotomy was performed.At surgery, an egg-sized tumor mass was found just beyond the ligament of Treitz, occupying the mesenteric border of the jejunum. No other abnor¬ malities were noted by the surgeon and the tumor was widely resected. Pathologic study revealed a lobulated, rubbery, cauliflower-like, subserosal tu¬ mor measuring 3X3 cm. in diameter. The mucosa of the jejunum overlying the tumor was dimpled and formed a pit about 1 cm. in diameter. The mucosa at this point was intimately attached to the body of the tumor, but elsewhere was freely movable over it. Microscopically the tumor proved to be a benign leiomyoma. The patient's post¬ operative course was uneventful and she was well when seen in follow-up 15 months later.Case 2.-This ...
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