Nine men and four women (median 69 years, range 38-86 years) with gastrointestinal leiomyosarcomas were treated from 1981 to 1991. Tumours arose from the stomach (5), the small intestine (6) and the rectum (2). Nearly half of all patients were surgical emergencies: one patient had perforation of the stomach and two of the small intestine from tumour ulceration, three cases presented with life-threatening bleeding from leiomyosarcomas of the small intestine. All patients were operated on, but only seven for cure. At follow-up one patient had emigrated and four had died, two from leiomyosarcoma after 13 and 36 months and two from unrelated causes after seven and 48 months. Two patients are still alive 24 and 78 months after surgery without recurrence. Patients and amenable to a curative operation died within nine months.