Leiomyoma of the Duodenum as a Cause of Recurrent Post-gastrectomy Bleeding.

EDITORIAL SYNOPSIS A patient with recurrent melaena over a period of four years is reported. He underwent four laparotomies. At the fourth operation a leiomyoma of the second part of the duodenum was found and successfully resected. The clinical features of leiomyomatous tumours of the duodenum are reviewed, and recurrent unexplained gastrointestinal haemorrhage is emphasized as a common manifestation. Tumours derived from the muscle coat of the duodenum are rare, and successful surgical treatment is even rarer (Weinstein and Roberts, 1953; Starr and Dockerty, 1955). A case of leiomyoma of the duodenum is presented because it illustrates some of the clinical features of leiomyomata, as well as an unusual pitfall which was encountered in the diagnosis of recurrent gastrointestinal haemorrhage. This case is one of the few recorded leiomyomatous lesions of the second part of the duodenum which have been successfully resected (Weinstein and Roberts, 1953). NOVEMBER 1957 A 36-year-old man with no past history of dyspepsia was admitted to his local hospital with severe melaena. The melaena persisted and laparo-tomy was performed but no obvious cause for the bleeding could be found. As there was blood in the duodenum and small bowel, the duodenum was opened and a bleeding point on the medial wall of the second part was found and under-run. He made an uneventful recovery. SEPTEMBER 1958 The patient was re-admitted to his local hospital with a severe, persistent melaena which necessitated a laparotomy. No causal lesion was found, and a 'blind' Polya partial gastrectomy was done. The melaena continued for several days and then stopped. His further convalescence was uneventful. AUGUST 1959 He was admitted to hospital with a further melaena, and a barium meal at this time showed normal post-gastrectomy appearances. oesophagus. Gastroscopy showed several black un-absorbed sutures hanging from the gastro-jejunal anastomosis. Those which could be seen were removed (using an attachment to the gastroscope) but it was thought possible that some sutures might not have been removed. At this stage it was assumed that the recurrent haemorrhages were due to ulceration around the un-absorbed sutures used in the gastro-jejunal anastomosis (Tanner, 1951). JANUARY 1960 At St. James's Hospital gastroscopy showed that some unabsorbed sutures were still present, but as he had had no bleeding for six months he was kept under review. OCTOBER 1960 The patient was re-admitted to his local hospital with melaena, which stopped spontaneously. He was again transferred to St. …