KAPOSFS SARCOMA WITH SECONDARY INVOLVEMENT OF THE JEJUNUM, PERFORATION AND PERITONITIS *

SINCE Kaposi's original description of multiple hemorrhagic sarcoma of the skin in 1872, more than 600 cases have been reported in the literature. In the great majority of these cases the skin has been primarily affected. A large number progress slowly for many years and at autopsy show no spread beyond the cutaneous site. However, the finding of sarcomatous deposits in the viscera is a common one. Almost every organ of the body has been implicated. In addition to the skin the most frequent sites of involvement are the penis, the gastrointestinal tract, the upper and lower respiratory tracts and the superficial and deep lymph nodes.1 Unusual localizations include the serous membranes, spleen, liver, adrenal glands, myocardium, mesentery, diaphragm, urinary bladder, thyroid and brain.2 Because of such widespread systemic involvement this disease must be kept in mind in the differential diagnosis of conditions manifesting multiple systemic complaints and physical findings. The alimentary canal may be involved wholly or in part from the oral cavity to the anus. The stomach and small intestine are most often affected, the large intestine and appendix less frequently. Gastrointestinal symptoms are not as a rule prominent but instances of severe diarrhea, abdominal pain, and hemorrhage have been described.3 A recent case is recorded 4 in which a 17 year old boy died of in-testinal intussusception caused by a solitary Kaposi nodule in the ileum. It has been emphasized that "death may occur from infiltration of the lungs, liver or spleen but by far the most common sequence is metastasis to the intestinal mucosa with ulceration causing hemorrhage and exsanguination."8 The statement has been made that "intestinal perforation and intraabdominal adhesions have not been described.,,1 It is the purpose of this presentation to record a case of Kaposi's sarcoma in which the skin was involved for many years before a secondary mass in the jejunum perforated, causing generalized peritonitis and death