A 62-year-old man experienced recurrent painless episodes of melenas and undiagnosed chronic
anemia for 4 years. Despite extensive radiologic and endoscopic work-up, the origin of the bleeding
could not be identified. At his last admission, visceral angiography revealed an area of hypervascularity
at the initial portion of the jejunum, containing irregular, corkscrew vessels coming from
the first jejunal branch of the superior mesenteric artery. Under general endotracheal anesthesia,
a 10-mm trocar for the 30 degree laparoscope was inserted subumbilically using the open Hasson
technique. Two 5-mm trocars were also used suprapubically and at the left iliac fossa. A 2.5 cm diameter,
smooth, hypervascular tumor was easily visualized on the jejunal wall 10 cm from the ligament
of Treitz. The small bowel segment was laparoscopically mobilized and brought through the
subumbilical trocar site, which was extended 1 cm. A limited small bowel resection and a stapled
anastomosis were easily performed extracorporeally. Histopathologic examination diagnosed a benign
gastrointestinal tumor (gastrointestinal stromal tumor, leiomyoma). The patient was discharged
on postoperative day 2.
Laparoscopic identification and mobilization allows a loop of small bowel to be exteriorized
through a small incision; the anastomosis can be safely performed extracorporeally. The advantages
of rapid postoperative recovery and reduced pain are evident.
