A CASE OF JEJUNAL LEIOMYOSALCOMA PRESENTING AS LIVER ABSCESS

A 71-year-old woman was admitted to the hospital because of cryptgenic fever, general fatigue and right hypochondralgia. Ultrasonography and computed tomography showed a liver abscess and a solid tumor in the left lower abdomen. Percutaneous abscess drainage under ultrasonic guide and antibiotic injection resulted in remission, but the left lower abdominal tumor was no change and she had intermittent melena. An abdominal angiogram suggested a leiomyiosalcoma of the jejunum which is feeded from the second jejunal artery. On laparotomy, the tumor originated in the jejunum, 20cm distal from Treitz's ligament, it had a central necrosis which communicated with the jejunum through the fistula. Liver metastasis was not detected. Histologically, it was concluded to be leiomyosarcoma. A Streptococcus intermedius was found in the abscess culture. So, the liver abscess was portal seeding. We have been able to find only 8 previous reports of the liver abscess complicating with the small bowel tumor.