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. 2018:42:261-265.
doi: 10.1016/j.ijscr.2017.12.033. Epub 2017 Dec 27.

Ileal GIST presenting with bacteremia and liver abscess: A case report and review of literature

Marina Gorelik  1 , Braulio Sabates  2 , Adel Elkbuli  2 , Tony Dunne  2
Affiliations

Ileal GIST presenting with bacteremia and liver abscess: A case report and review of literature

Marina Gorelik et al. Int J Surg Case Rep. 2018.

Abstract

Introduction: Small intestine gastrointestinal stromal tumors can infrequently present with intra-abdominal abscess, perforation, obstruction or fistula. Tumor-small intestine fistula is a rare phenomenon and occurs as a result of GISTs' propensity to cause mucosal ulceration. This allows bacteria from the gut to gain access to the systemic circulation and predisposes the patient to bacteremia and pyogenic liver abscess.

Presentation of case: We present a case of a 63-year-old female whose initial symptoms included fever, nausea, vomiting and right upper quadrant pain. Radiologic studies revealed a liver lesion and an intra-abdominal mass containing oral contrast, suggesting involvement of the gastrointestinal tract. She was found to have a liver abscess, Streptococcus anginosus bacteremia and an ileal GIST that formed a fistula between the tumor and small intestine. We performed a surgical resection of the tumor and percutaneous drainage of the liver abscess. Imatinib was initiated post operatively and she experienced no recurrence, as demonstrated by a surveillance computed tomography scan at 12 months.

Conclusion: Findings of a liver lesion in association with a small intestine GIST should raise concern for both metastatic disease and a possible infectious complication such as a pyogenic liver abscess. If a member of the Streptococcus milleri group is isolated in blood cultures, a consideration for gastrointestinal malignancy is imperative. This case report reviews a rare presentation of an ileal GIST with tumor-intestinal fistula, complicated by liver abscess and Streptococcus anginosus bacteremia.

Keywords: Case report; Fistula; GIST; Liver abscess; Small intestine; Streptococcus anginosus.

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Figures

Fig. 1
Fig. 1
Liver lesion (arrow) identified on a CT scan of the abdomen.
Fig 2
Fig 2
CT scan of the abdomen and pelvis with an intra-abdominal mass containing internal air-fluid levels (arrow).
Fig. 3
Fig. 3
CT of the abdomen and pelvis demonstrating oral contrast in the center of the intra-abdominal mass (arrow).
See this image and copyright information in PMC

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