Myoma of the Stomach and of the Duodenum

Abstract

In both of the cases reported herewith, the X-ray findings made it possible to diagnose the condition as benign tumor. Case 1 (A432691). A druggist, thirty-nine years of age, came to the Clinic July 11, 1923, complaining of diarrhea and melena. He had first observed tarry stools three years before, and at this time he had been constipated. Shortly afterward the constipation alternated with diarrhea, occurring about every ten days, with occasionally tarry stools. One year before, he had had diarrhea for a month, with very dark stools, and had become very weak and anemic, but within a month he had regained most of his strength. Ten days before coming to the Clinic, he began to have diarrhea as before. He also complained of much gas and belching. He was able to eat all varieties of food, but said that he felt better with his stomach empty. He had lost but 10 pounds in weight. The physical examination was negative. An examination of the urine was negative. The hemoglobin was 61 per cent, erythrocytes numbered 3,790,000, the leukocytes 9,800; the color index was 0.8. Examination of the gastric contents revealed a total acidity of 56, free hydrochloric acid 36, and a large amount of blood. The blood Wassermann reaction was negative. An X-ray examination of the stomach disclosed a more or less circumscribed filling defect in the lower third, and a palpable tumor corresponding to it (Fig. 1). Owing to the circumscribed appearance of the filling defect and the fact that the curvatures of the stomach were not involved, a diagnosis of benign tumor was made. An X-ray examination of the colon was negative. Operation was advised. The patient went home to arrange his affairs and returned for operation August 6, 1923. The hemoglobin at this time was 44 per cent, the erythrocytes numbered 2,850,000, the leukocytes 6,300, and the color index was 0.7. At operation, a benign tumor which apparently involved all the coats of the stomach was found on the anterior surface, just off the lesser curvature in the middle portion of the stomach (Fig. 2). An examination of the liver was negative. A resection was performed through a median line incision, and an end-to-end anastomosis was made. A pathologic examination of the specimen showed it to be an edematous hemorrhagic myoma 4 by 3.5 by 3 cm. with an ulcerated necrotic area on the mucous surface (Fig. 3). A microscopic examination of the tissue confirmed the gross diagnosis. Case 2 (A434648). A farmer, forty years of age, came to the Clinic July 25, 1923, complaining of melena. Two years before, he had been buried in a gravel pit and extricated with some difficulty. Immediately after the injury he had a few attacks of vomiting. A few days later he felt a soreness in the right upper abdomen, and noticed that his stools were at times black and tar-like. Since then, he had always had a dull pain in the abdomen, especially one to two hours after meals, and associated with some bloating and belching.