Surgical management of duodenal leiomyomas

Duodenal leiomyomas are rare neoplasms and when present are usually asympto matic. There are, however, isolated case reports of such leiomyomas giving rise to complications including gastrointestinal hemorrhage and obstruction . The purpose of this study was to review the surgical experience with duod enal leiomyomas at a large tertiary referral center. A retrospective review was performed of all patients with histologically proven duodenal leiomyom as encountered from 1975 to 1995. Twelve patients with surgically treated d uodenal leiomyomas were identified, There were eight men and four women wit h a mean age of 57 years (range 20-73 years) at diagnosis. Anemia was the p resenting sign in 10 patients (83%). The mean hemoglobin level at presentat ion was 10.8 +/- 2.67 g/dl. Other presenting signs included melena (n = 5) and epigastric tenderness (n = 4), No patient had obstructive symptoms. Upp er endoscopy visualized the lesion in 9 of 10 patients, but endoscopic biop sy provided an accurate histologic diagnosis in only two of six patients bi opsied. All resected specimens underwent frozen section and permanent histo pathologic analysis. Local excision was performed in eight patients, as ben ignancy was anticipated at surgical exploration and frozen section findings . Two patients underwent segmental duodenal resection with primary end-to-e nd anastomosis, and two patients underwent a Whipple procedure. There was n o perioperative mortality. Morbidity was minimal. There was no tumor recurr ence during a median follow-up of 8.4 years. Gastrointestinal blood loss is the most common complication of duodenal leiomyomas requiring surgical int ervention. Small symptomatic leiomyomas with benign features may be safely treated with local excision.