Abstract
Recently we experienced a case of leiomyoma of the duodenum presenting with massive hematemesis due to an arterial bleeding. A 53-year-old woman was admitted to a nearby hospital because of general fatigue and nausea followed by massive hematemesis. Emergency endoscopic examination revealed a bleeding from a submucosal tumor at the second portion of the duodenum. Endoscopic injection of ethanol into the trickling bleeding point of the tumor was performed and a transient hemostasis was achieved. Two days after the local injection of ethanol, massive hematemesis recurred and the patient was tranferred to the hospital. Emergency upper GI endoscopy revealed an arterial bleeding from the central portion of the submucosal tumor at the second portion of the duodenum. Under an emergency laparotomy, a firm tumor at the anterior wall of the duodenal second portion was escised.
Macroscopically, the tumor was 30×26×20mm in size and revealed lobulated and encapsulated surface. Histopathologically this tumor was leiomyoma with no malignant change and an arterial thrombosis associated with diffuse necrotic foci was seen at the mucosal surface, possibly resulting from the local injection of ethanol. Since leiomyoma is commonly hypervascular, an attention to a passible rebleeding is needed especially when local injection of ethanol is applied to the bleeding leiomyoma.
