A Case of a Small Bowel Leiomyoma of Extra-tubular Growth Type Presented with a Mass in the Left Hypochondriac Region

Abstract

A 44-year-old woman presented to our hospital with a mass in the left hypochondriac region that had been present for the past 5 years, with an increase in the mass with pain over the past 6 months. Enhanced computed tomography of the abdomen revealed a tumor located on the left side of the abdominal cavity, caudal to the pancreas and ventral to the left kidney. The pancreas was compressed to the cephalad region and the boundaries were clear. Because the tumor showed an increasing tendency and a possibility of malignancy could not be ruled out, diagnostic resection was performed. Laparotomy showed that the tumor had arisen from the small bowel wall as a submucosal tumor near the Treitz ligament and extended to the retroperitoneum at the inferior border of pancreas. Without damaging other organs, we performed tumor removal with partial resection of the small intestine. The jejunum was lifted on the dorsal aspect of the transverse colon and an overlap anastomosis with the descending part of duodenum was done. The histopathological diagnosis was leiomyoma of the extra-tubular growth type. The postoperative course was uneventful and the patient was discharged from the hospital on the 14th postoperative day. Diagnostic resection is often performed for intra-abdominal masses because a definitive diagnosis is a challenge before surgery. Most jejunal masses are clinically silent for a long time and are often detected when they grow large. We encountered a case of a giant leiomyoma with extra-tubular growth type presented with a mass in the left hypochondriac region.