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. 2012;3(2):82-5.
doi: 10.1016/j.ijscr.2011.10.018. Epub 2011 Nov 15.

Acute pancreatitis secondary to a prolapsed gastric fundal GIST

Owain Jones  1 , David Monk, Trevor Balling, Ann Wright
Affiliations

Acute pancreatitis secondary to a prolapsed gastric fundal GIST

Owain Jones et al. Int J Surg Case Rep. 2012.

Abstract

Introduction: Gastrointestinal stromal tumours (GISTs) account for less than 3% of all gastrointestinal tract tumours and 5.7% of all sarcomas, and the majority of these tumours are gastric in origin. Patients commonly present with gastrointestinal bleeding or abdominal pain with 10-30% of patients presenting with symptoms of gastrointestinal obstruction.

Presentation of a case: We present a case of a 65-year-old gentleman who presented with symptomatic iron deficiency anaemia. Gastroscopy revealed a large submucosal lesion originating from the gastric fundus, consistent with a GIST. The patient developed acute epigastric pain, vomiting with raised inflammatory markers. A CT of the abdomen revealed the GIST to be causing gastric outlet obstruction as result of a prolapse of the tumour through the pylorus into the duodenum. This also resulted in compression of the distal common bile duct and was associated with the radiological appearance of acute pancreatitis. This responded to conservative management. The GIST was resected subsequently using a laparoscopic technique.

Discussion: Only one similar case has previously been reported in the literature. Several surgical approached have been described in the management of gastric GISTs including open, laparoscopic, hand assisted, ultrasound assisted and a combined endoscopic and laparoscopic approach. A laparosopic 'eversion' techinque was preferred in our case due to the close proximity of the tumour to the gastro-oesophageal junction.

Conclusion: Pancreatitis secondary to a prolapsed gastric GIST is a rare entity. Laparoscopic wedge resection of these tumours can be safely performed with a satisfactory oncological outcome.

Keywords: Acute pancreatitis; GIST; Gastric outlet obstruction; Stomach; Wedge resection.

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Figures

Image 1
Image 1
Gastroscopy image revealing a large submusosal lesion in close proximity to the gastro-oesophageal junction.
Image 2
Image 2
Contrast enhanced CT slice showing a 7.5 cm intragastric lesion arising from the posterior aspect of the fundus.
Image 3
Image 3
GIST prolapsed into the duodenum with associated peripancreatic inflammation consistent with pancreatitis. The inferior portion of the single large gallstone can be seen in Hartmann's Pouch. A nasogastric tube is seen in the stomach.
Image 4
Image 4
Intraoperative images (Left Upper) The prolapsed gastric fundus which was irreducible with traction. (Right Upper) Anterior gastrostomy revealing the reduced GIST which has now been reduced following intravenous Buscopan. (Left Lower) Eversion of the GIST through the gastrostomy preparing for a wedge resection. (Right Lower) Anterior gastrostomy closed with a single layer of Vicryl.
Image 5
Image 5
The excised specimen.
See this image and copyright information in PMC

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