Jesse J. Xie, MD1, Royce Kim, DO2 1Sentara CarePlex Hospital, Hampton, VA; 2Sentara Health, Poquoson, VA Introduction: Small bowel tumors make up only an estimated 2% of all gastrointestinal (GI) tumors and leiomyosarcoma (LMS) account for roughly 0.1-3% of that fraction1. Diagnosis is often delayed due to nonspecific symptoms and patients typically present with late stage disease, obstruction, and perforation2. LMS normally occurs in individuals over 50 years old and presentation with GI bleeding is particularly uncommon1,2. Here we present an atypical case of a young, healthy male diagnosed with bleeding small bowel LMS.
Case Description/
Methods: A 24 year old male with no past medical history presented with melena in the setting of heavy daily NSAID use for 1 week to alleviate a toothache. Initial workup revealed hemoglobin of 6.5 g/dL. Esophagogastroduodenoscopy (EGD) was unremarkable. Push enteroscopy revealed a bleeding jejunal diverticulum with surrounding swirling mucosa. Following epinephrine injection and endoscopic clipping, hemostasis was achieved but hemoglobin continued to downtrend. Computed tomography (CT) of the abdomen and pelvis showed a 13 cm heterogeneously enhancing pelvic mass originating from the small bowel. Complete surgical resection of the mass and involved jejunum was performed with pathology revealing low grade small bowel LMS. Discussion: LMS is rarely considered in the differential diagnosis of melena in otherwise young, healthy patients. This case illustrates an atypical presentation of small bowel LMS in a young adult without risk factors, with initial misleading findings of a bleeding diverticulum and heavy NSAID use. This case demonstrates the importance of maintaining a broad differential when initial endoscopic evaluation is unrevealing and highlights value of early broadening of differentials when atypical endoscopic findings are seen. Multidisciplinary collaboration facilitated timely management and favorable outcomes in this case.
References 1. Fawaz M, Kataria K, Singh A, Samadder S. Small intestine leiomyosarcoma mimicking gastrointestinal stromal tumour. BMJ Case Rep. 2021;14(9):e244381. Published 2021 Sep 13. doi:10.1136/bcr-2021-244381 2. Fukai S, Lefor AK, Nishida K. Perforation of intestinal leiomyosarcoma: A case report. Int J Surg Case Rep. 2021;79:327-330. doi:10.1016/j.ijscr.2021.01.062
Disclosures: Jesse Xie indicated no relevant financial relationships. Royce Kim indicated no relevant financial relationships.
Jesse J. Xie, MD1, Royce Kim, DO2. P0978 - A Rare Case of Small Bowel Leiomyosarcoma Presenting as Ongoing Gastrointestinal Bleeding in a Young Adult Male, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
