After 5 days of emesis and near‐syncope, an 86‐year‐old man presented with weakness, nausea, and altered mental status. His emesis appeared nonbilious and contained regurgitated food. He had known dementia and lived with his son, who stated that the patient was less verbal than usual and had worsening urinary incontinence. Three months prior, he had been treated with ciprofloxacin for a urinary tract infection; he had a history of radiation for prostate cancer in 1999, as well as obstructive uropathy with bilateral hydronephrosis in 2010. He was thin‐appearing, afebrile, and oriented to self only. His heart and lung exams were normal. He had normal active bowel sounds with minimal abdominal tenderness, worse in the suprapubic area. There was no rebound nor guarding. His extremities were nonedematous and he had no focal neurological deficits. Urinalysis revealed large leukocyte esterase. Despite treatment of his UTI with appropriate antibiotics, his nausea and vomiting progressively worsened. Computerized tomography (CT) of the abdomen and pelvis revealed an antral mass with partial gastric outlet obstruction. Esophagogastroduodenoscopy (EGD) with biopsy identified the mass as a submucosal gastric leiomyoma. Nasogastric suction was followed by gastrojejunostomy with placement of nasojejunostomy tube. The patient was discharged in stable condition tolerating oral intake.
Leiomyomas and leiomyoblastomas comprise 2% of all resected gastric neoplasms; they have a 25% occurrence in the antrum, compared with 40% in the corpus. They occur most frequently in 50‐ to 70‐year‐old men. Most patients are asymptomatic for months to years. Presentation varies according to size, location, and associated complications. The most common presenting symptoms are bleeding, abdominal pain, nausea, weight loss, intestinal obstruction, and jaundice. Pancreatitis may also occur. CT scan and EGD are the preferred diagnostic methods, but definitive diagnosis cannot be achieved without biopsy. Leiomyomas have a low rate of malignant transformation (12%), but malignancy potential can be difficult to ascertain on biopsy because they are unencapsulated tumors.
This case illustrates the clinical presentation and characteristics of a relatively rare gastric tumor that masqueraded as an infection‐related complication in a patient with limited reliability as a historian. Rigorous assessment of mental status in an elderly patient is necessary, especially when history taking is limited by cognitive impairment or an absent caretaker. It is important to consider less common sources of symptoms when they fail to improve with standard treatment.
To cite this abstract:Magda G, Hanson S, Egan A, Guidry M. What Goes Down Must Come Up: Gastric Leiomyoma in a Patient with Dementia. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 252. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/what-goes-down-must-come-up-gastric-leiomyoma-in-a-patient-with-dementia/. Accessed May 24, 2019.