Bleeding jejunal leiomyoma: a new approach

Leiomyomas represent one of the most common benign neoplasms of the small intestine. Most of these are asymptomatic and are found incidentally at surgery or autopsy; however, leiomyomas may present with prominent signs and symptoms. Bleeding is the most common clinical problem and is occasionally life-threatening. We report the case of a 90-yr-old man who presented with rectal bleeding that became massive within hours, necessitating blood transfusion. An arteriogram revealed significant 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 of ischemic bowel was identified, and a 4.5-cm extraluminal jejunal mass was resected. Pathological examination confirmed a tissue diagnosis of leiomyoma. Our Med-Line search revealed very few cases of jejunal leiomyoma that had presented initially as massive rectal bleeding. There were no cases of embolization followed by therapeutic laparoscopy.