Case Report: Jejunal gastrointestinal stromal tumour, a rare tumour, with a challenging diagnosis and a successful treatment

Abstract

Gastrointestinal stromal tumours (GISTs) are rare. GISTs comprise 0.2% of gastrointestinal tumours and only 0.04% of small intestinal tumours. Jejunal GISTs are the rarest subtype. Only 10-30% progress to malignancy [Choi (Response evaluation of gastrointestinal stromal tumors. Oncologist 2008; 13: :4-7)]. We present a 70-year-old male, with multiple co-morbidities, who had extensive investigations over 5 years for vague abdominal pain. All investigations were normal. He presented with symptoms and signs of small bowel obstruction (SBO), confirmed on a computed tomography scan and demonstrated to be secondary to lesion-induced intussusception. The patient had emergency small bowel resection, was discharged after 4 days and remains well. This case report highlights the rarity of jejunal GISTs and, as extensive initial investigation yielded all false-negative results, indicates the difficulty in diagnosing jejunal GISTs. Adhesions are the commonest cause of SBO in patients with previous abdominal surgery, followed by newly diagnosed malignancies [Beardsley et al. (Small bowel obstruction in the virgin abdomen: the need for a mandatory laparotomy explored. Am J Surg 2014; 208: :243-8)]. Consequently, in patients with a virgin abdomen, underlying tumours should be considered.

Figure 1:

Abdominal X-ray showing SBO.

Figure 2:

CT showing intussusception secondary to a lesion.

Figure 3:

Excised intussusception.

Figure 4:

Excised GIST.