[Leiomyomas and massive digestive hemorrhages--case reports of patients diagnosed in 2004]

Abstract

Introduction: During 2004, there were 6 patients with leiomyomas diagnosed and treated at the Department of Gastroenterology and Clinical Pathology of the Zemun Clinical Center. The most common location of these benign submucosal tumors is stomach, followed by small intestine and large intestine.

Case report: The most common symptoms of these patients were massive intestinal hemorrhage, with haematemesis and melaena. Hemorrhages resulted from superficial lesions, caused by pressure of the tumour on the intestinal blood vessels. A significant contribution in reaching the final diagnosis and selecting appropriate therapeutic approach was provided by CT and arteriography. Most patients underwent surgical treatment, which provided precise diagnosis (based on histopathologicalfindings), and at the same time a definite therapeutic procedure.

Discussion and conclusion: According to the literature data, gastrointestinal leiomyomas account for 20%-30% of all types of gastrointestinal tumors. Our research revealed that the incidence of leiomyomas was significantly lower within our group of patients, accounting for 12% of all benign gastrointestinal tumors. They were also the main cause of hemodynamic instability in our patients having massive and recurrent intestinal hemorrhages, which is not often seen in practice. All of them originated either from muscularis propria or muscularis mucosae. These tumors are often an accidental finding at autopsy, especially if they are smaller than 3 centimeters and not followed by consequential complications. Presently, endoscopic ultrasonography is considered to be the the most accurate procedure in the diagnosis of leiomyoma, with a diagnostic specificity that is superior to other imaging techniques.