Abstract

Tumors of the small intestine are rare, especially perforated primary leiomyosarcoma of the small intestine. Recently we experienced a case of leiomyosarcoma of the small intestine with liver metastasis presenting with perforation of the small intestine. A 51-year-old woman visited another hospital because of abrupr development of severe pain in the lower quadrant on July 22 1992, but the symptom did not improve and the patient was seen at the emergency center of Saga Medical School on the same day. Muscular defense was positive in the entire abdomen. Abdominal simple X-ray film revealed no free air, but patient was diagnosed as acute generalized peritonitis. Emergency operation was performed. A tumor with the size of adult's fist (10×5cm) was found about 80cm distant from the terminal ileum; it arised in the antimesenteric side; and a part of it necrotized and perforated. Partial excision of the ileum including the tumor and radical treatment of peritonitis were carried out. Postoperative abdominal CT visualized a solitary tumor 4cm in diameter in S7 region of the right hepatic lobe. Based on pathological findings of the exercised specimen, angiography, and MRI, it was diagnosed as hepatic metastasis of leiomyosarcoma of the small intestine. On September 2nd, right lobectomy was carried out. Postoperative course was uneventful.

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