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What xray is shown. What are the findings and what is the diagnosis?
How does this condition usually present and how is it usually diagnosed?
What is the management?
This is a barium meal showing a large polypoid lesion in the fundus which is typical of a leiomyoma. This usually presents with GI bleeding. It is simply resected with a small margin of normal tissue as mlaignancy is rare. Both endoscopic and laparoscopic approaches have been described. (See below for further details.)
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(See below for further details)
This is a barium meal showing an oblique view of the stomach. There is a large smooth filling defect in the upper part of the stomach in the middle of which a speck of barium is stuck. The smooth lesion in the upper part of the stomach denotes a benign submucosal tumour which has ulcerated through the mucosa in the central part causing a small amount of barium to be stuck in the central part. The diagnosis is a typical leio-myoma.
The usual presentation is one of haematemesis and melaena; usually it is haematemesis without any history of indigestion and the patient may complain of early satiety. Because the patients come as an emergency with acute gastrointestinal haemorrhage, the diagnosis is usually made by endoscopy. This particular patient had small herald bleeds and during a quiescent period a barium meal was carried out.
These tumours as best treated by local resection with a surrounding margin of 1-2 cm. Although there is a malignant variant of leiomyoma called a leiomyosarcoma, the histological differentiation may be difficult. Please see flow chart for the management of acute upper gastrointestinal haemorrhage.