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. 2018:53:354-357.
doi: 10.1016/j.ijscr.2018.11.021. Epub 2018 Nov 16.

Surgical treatment of giant gist with acute gastrointestinal bleeding: Case report

Catarina Melo  1 , Carolina Canhoto  2 , Fernando Manata  3 , António Bernardes  4
Affiliations

Surgical treatment of giant gist with acute gastrointestinal bleeding: Case report

Catarina Melo et al. Int J Surg Case Rep. 2018.

Abstract

Introduction: Gastrointestinal stromal tumors represent about 1% of the tumors of digestive tract. Their presentation consists often of indolent symptoms. However, they can present as surgical emergencies in rare cases. This work presents a case of a giant jejunal GIST that required emergent surgical treatment.

Case presentation: A 60-year-old male presented with abdominal pain and acute low gastrointestinal bleeding. During observation a palpable mass was detected in the periumbilical region, left hypochondrium and left flank. A non-total colonoscopy was inconclusive. An Angio-CT showed a large exophytic tumor arising from the 4th duodenal segment and first jejunal segment with approximately 20 × 14 x 13 cm, with apparent intratumoral bleeding. Due to haemodynamic instability, the patient was submitted to emergency laparotomy, in which a large tumor was found arising from the first jejunal segment. A segmental enterectomy was performed and the post-operative period ran without complications. The histopathologic exam showed a gastro-intestinal stromal tumor of epithelioid cell nature, with low mitotic count (<5 per 50HPF), categorized as T4N0 stage IIIA. The imunohistochemical analysis revealed positivity for CD117 (c-kit) and DOG-1. The patient started Imatinib therapy, and is free of disease recurrence for 3 years.

Conclusions: This case pretends to review an unusual presentation of a giant jejunal intestinal GISTs as well as its management in an emergent context.

Keywords: Emergency surgery; Gastrointestinal bleeding; Gastrointestinal stromal tumor; Jejunal tumor.

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Figures

Fig. 1
Fig. 1
CT scan showing a large tumor arrising from the first jejunal segment: A. Sagital image; B. Coronal image.
Fig. 2
Fig. 2
Image of the tumor found during exploratory laparotomy.
Fig. 3
Fig. 3
Detail of the tumoral mass arrising from the first jejunal segment.
Fig. 4
Fig. 4
Image of the duodenal-jejunal anastomosis.
See this image and copyright information in PMC

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