A CASE OF PERFORATION OF THE JEJUNAL DIVERTICULUM ASSOCIATING WITH A LEIOMYOSARCOMA

A 63-year-old man had repeated melena of unknown origin from March 10, 1991. On February 7 1992, the patient developed melena followed by abdominal pain in the early morning and was referred to the hospital for admission. There were tenderness with muscular defence and Blumberg sign in the abdomen. Simple X-ray examination of the chest and abdomen showed free air under the diaphragm. From these findings the patient was diagnosed as having a gastrointestinal perforation. Laparotomy was immediately performed and a diverticulum with a perforation 8mm in diameter in the jejunum at 2mm anal side from the Treitz ligament was found. The diverticulum was 8cm in size, was located on the antimesenteric side, and a hard tumor mass with the size of tip of the finger was palpated in a part of the wall. Partial excision of the jejunum including the diverticulum was performed. This case was of true diverticulum of the jejunum associating with an extramural lyomiosarcoma in which tumor cells invaded almost entire the diverticulum and the perforation was formed in its ulcerated part. In this paper a rare case of jejunal diverticulum with a leiomyosarcoma in which hemorrhage was repeated from erosion and ulcer in the lumen probably forming a perforation is described.