Bowel perforation and peritonitis caused by a jejunal leiomyoma. A rare complication of jejunal leiomyoma

Abstract

Small-bowel leiomyomas are rare, usually indolent, benign neoplasms, sporadically associated with complications, mainly including bleeding and obstruction. Herein we report a case of a 78-year-old female patient under high-dose corticosteroid treatment for systemic disease, presenting with clinical signs suggestive of peritonitis. Urgent exploratory laparotomy revealed an intraluminal jejunal mass complicated by bowel perforation and multiple enlarged mesenteric lymph nodes. Microscopic examination of the surgical specimen suggested the presence of a jejunal leiomyoma as the cause of perforation and lymph nodes’ infiltration by Hodgkin lymphoma. The patient died on the 15th post-operative day due to pulmonary complications. To our knowledge, this is the first reported case of a jejunal leiomyoma complicated by bowel perforation and peritonitis. A high index of suspicion for the presence of underlying neoplastic disease should be maintained in cases of non-traumatic small-bowel perforation. Additionally, the potentially detrimental effect of comorbidities on a patient’s outcome should be considered even in the context of successful management of primary disease.