Jejunal perforated gastrointestinal stromal tumor as a rare cause of acute abdomen: case report and review of literature
DOI:
https://doi.org/10.18203/2320-6012.ijrms20252799Keywords:
Jejunal perforated gastrointestinal tumor, Gastrointestinal stromal tumors , Acute abdomen, Stromal tumor, Jejunal tumorAbstract
Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumor of the GI tract. Most cases are asymptomatic, or present as an abdominal mass. Less frequently, they can present as an upper GI bleed or acute abdomen. We hereby present the case of a 47-year-old male who visits the ER department complaining of abdominal pain and melena, with physical exploration findings of acute abdomen. An abdominal computed tomography (CT) scan was performed, where a free intra-abdominal fluid was seen in left upper quadrant and a tumor like mass was detected in small intestine causing bowel obstruction for which he underwent exploratory laparotomy, finding a perforated jejunal GIST. An emergency exploratory laparotomy was performed due to the clinical findings of acute abdomen, upon organ examination, hemoperitoneum was found and intestinal leakage due to a mass in a segment of jejunum 25 cm from Treitz angle, an intestinal resection and anastomosis was performed. GISTs are common tumors that rarely present to the emergency room as an acute abdomen. It is important to the surgeon to bear this in mind and have knowledge of the specifics of management of these type of patients to provide an adequate surgical resection and postoperative risk specific follow up.
Metrics
References
REFERENCES
Søreide K, Sandvik OM, Søreide JA, Giljaca V, Jureckova A, Bulusu VR. Global epidemiology of gastrointestinal stromal tumours (GIST): A systematic review of population-based cohort studies. Cancer Epidemiol. 2016;40:39-46. DOI: https://doi.org/10.1016/j.canep.2015.10.031
Corless CL, Barnett CM, Heinrich MC. Gastrointestinal stromal tumours: origin and molecular oncology. Nat Rev Cancer. 2011;11(12):865-78. DOI: https://doi.org/10.1038/nrc3143
Joensuu H, Hohenberger P, Corless CL. Gastrointestinal stromal tumour. The Lancet. 2013;382(9896):973-83. DOI: https://doi.org/10.1016/S0140-6736(13)60106-3
Heikki Joensuu, Reichardt A, Eriksson M, Hohenberger P, Boye K, Cameron S, et al. Survival of patients with ruptured gastrointestinal stromal tumour treated with adjuvant imatinib in a randomised trial. Br J Cancer. 2024;11. DOI: https://doi.org/10.1038/s41416-024-02738-z
Nishida T, Hølmebakk T, Raut CP, Rutkowski P. Defining Tumor Rupture in Gastrointestinal Stromal Tumor. Ann Surg Oncol. 2019;26(6):1669-75. DOI: https://doi.org/10.1245/s10434-019-07297-9
Nishida T, Cho H, Hirota S, Masuzawa T, Chiguchi G, Tsujinaka T, et al. Clinicopathological features and prognosis of primary GISTs with tumor rupture in the real world. Ann Surg Oncol. 2018;25:1961-9. DOI: https://doi.org/10.1245/s10434-018-6505-7
Hølmebakk T, Hompland I, Bjerkehagen B, Stoldt S, Bruland ØS, Sundby Hall K, et al. Recurrence-free survival after resection of gastric gastrointestinal stromal tumors classified according to a strict definition of tumor rupture: a population- based study. Ann Surg Oncol. 2018;25:1133-9. DOI: https://doi.org/10.1245/s10434-018-6353-5
Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol. 2008;39(10):1411-9. DOI: https://doi.org/10.1016/j.humpath.2008.06.025
Hølmebakk T, Bjerkehagen B, Boye K, Bruland ØS, Stoldt S, Hall KS. Definition and clinical significance of tumour rupture in gastrointestinal stromal tumours of the small intestine. Br J Surg. 2016;103(6):684-91. DOI: https://doi.org/10.1002/bjs.10104
Joensuu H, Vehtari A, Riihimäki J, Nishida T, Steigen SE, Brabec P, et al. Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts. Lancet Oncol. 2012;13(3):265-74. DOI: https://doi.org/10.1016/S1470-2045(11)70299-6
Joensuu H, Eriksson M, Sundby Hall K, Reichardt A, Hermes B, Schütte J, et al. Survival Outcomes Associated With 3 Years vs 1 Year of Adjuvant Imatinib for Patients With High-Risk Gastrointestinal Stromal Tumors: An Analysis of a Randomized Clinical Trial After 10-Year Follow-up. JAMA Oncol. 2020;6(8):1241-6. DOI: https://doi.org/10.1001/jamaoncol.2020.2091
Joensuu H, Wardelmann E, Eriksson M, Reichardt A, Hall KS, Schütte J, et al. KIT and PDGFRA Mutations and Survival of Gastrointestinal Stromal Tumor Patients Treated with Adjuvant Imatinib in a Randomized Trial. Clin Cancer Res. 2023;29(17):3313-9. DOI: https://doi.org/10.1158/1078-0432.CCR-22-3980
Casali PG, Blay JY, Abecassis N, Bajpai J, Bauer S, Biagini R, et al. Gastrointestinal stromal tumours: ESMO–EURACAN–GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2021;33(1).
Kelly CM, Gutierrez Sainz L, Chi P. The management of metastatic GIST: current standard and investigational therapeutics. J Hematol Oncol. 2021;14(1). DOI: https://doi.org/10.1186/s13045-020-01026-6
Cassier PA, Fumagalli E, Rutkowski P, Schöffski P, Van Glabbeke M, Debiec-Rychter M, et al. Outcome of Patients with Platelet-Derived Growth Factor Receptor Alpha–Mutated Gastrointestinal Stromal Tumors in the Tyrosine Kinase Inhibitor Era. Clin Cancer Res. 2012;18(16):4458-64. DOI: https://doi.org/10.1158/1078-0432.CCR-11-3025