BLEEDING JEJUNAL LEIOMYOMA - A NEW APPROACH

Leiomyomas represent one of the most common benign neoplasms of the sm all intestine. Most of these are asymptomatic and are found incidental ly at surgery or autopsy; however, leiomyomas may present with promine nt signs and symptoms, Bleeding is the most common clinical problem an d is occasionally life-threatening. We report the case of a 90-yr-old man who presented with rectal bleeding that became massive within hour s, necessitating blood transfusion. An arteriogram revealed significan t hemorrhage from the jejunal branch of the superior mesenteric artery (thought to be arteriovenous malformation). Arterial embolization was performed, followed after 36 h by therapeutic laparoscopy. The area o f ischemic bowel was identified, and a 4.5-cm extraluminal jejunal mas s was resected. Pathological examination confirmed a tissue diagnosis of leiomyoma. Our Med-Line search revealed very few cases of jejunal l eiomyoma that had presented initially as massive rectal bleeding. Ther e were no cases of embolization followed by therapeutic laparoscopy.