<Case Reports>Leiomyosarcoma of the small intestine presenting with peritonitis and melena

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This report describes a 67-year-old man with leiomyosarcoma of the small intestine, who presented with peritonitis and melena resulting from tumor necrosis and rupture. The patient was admitted to a local clinic for evaluation of abdominal pain and fever, and was transferred to our hospital after detection of a palpable mass in the lower abdomen as well as melena. On admission, a tender mass was palpable in the lower abdomen, and Blumberg's sign and muscular guarding were noted. Ultrasonography and computed tomography of the abdomen showed a gas-filled mass indicative of an intraperitoneal leiomyosarcoma communicating with the intestinal tract. The patient underwent emergency surgery for generalized peritonitis resulting from tumor necrosis and rupture. At operation, purulent ascitic fluid was noted. A mass as large as the head of a child was located in the jejunum about 40cm distal to the ligament of Treitz, and protruded toward the peritoneal cavity. The tumor had adhered to and directly infiltrated the sigmoid colon and the rectum. Partial resection of the small intestine was performed along with sigmoidectomy and proctectomy. Histological examination of the resected specimen established a diagnosis of primary jejunal leiomyosarcoma. Since the tumor was quite large, an inadequate blood supply might have caused central necrosis and cavitation communicating with the intestinal mucosa with rupture into the peritoneal cavity.
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