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Massive Hemorrhage (Melena) Due to Leiomyosarcoma of the Jejunum

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Abstract

This report is submitted because of the rarity of the condition, the fact that the patient presented features of considerable interest from the standpoint of differential diagnosis, and because the lesion is a rare cause for massive hemorrhage from the gastrointestinal tract. A diagnosis of functional indigestion was made at the time of the original examination.

One and a half years later the patient entered the hospital as an emergency case with a blood count of 33 per cent hemoglobin and 2,760,000 red cells. A working diagnosis of peptic ulcer was made because typical hyper-acidity symptoms were presented. Three weeks previously detailed roentgen examinations of the entire digestive tract, including studies of the small intestine, had disclosed no abnormality. When the patient did not make a satisfactory response to medical ulcer management, which included five 500 cc. blood transfusions, under our care, Dr. J. G. Root demonstrated abnormality at the site of the lesion by roentgen examination, even though the tumor was extraluminal and caused no obstruction (small diverticulum). He also demonstrated a Meckel’s diverticulum, an exceedingly rare roentgenologic finding. The preoperative diagnosis was massive hemorrhage due to “peptic ulcer” in a Meckel’s diverticulum.

At operation, performed by Dr. T. E. Jones, no ulceration was found in the Meckel’s diverticulum, but an extraluminal mass measuring 6 x 4 x 3 cm. was found in the upper jejunum at the site of the “small diverticulum” previously demonstrated by roentgen examination. Eight centimeters of the jejunum, including the mass, were resected, and. . .


 

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