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Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors
Published on: February 19, 2022
[Perforation of Small Intestinal Gastrointestinal Stromal Tumor Required Emergency Surgery-A Case Report]
Masanori Ikota1, Taku Akahoshi, Ippei Murata
1Dept. of Surgery, Chiba Tokushukai Hospital.
Abstract:
The case was a 77-year-old man. He presented with abdominal pain and melena to our hospital. Abdominal CT showed thickening of the small intestinal wall and findings of intraperitoneal free air. Suspecting peritonitis due to small intestinal tumor perforation, we performed an emergency surgery. A ruptured tumor measuring 50 mm in diameter was found in the jejunum about 15 cm from the Treitz' ligament and the partial resection of the small intestine was performed. Histopathology revealed fistulous necrosis within the tumor, and immunostaining was positive for KIT and CD34, leading to the diagnosis of jejunal GIST. He was evaluated as high risk for recurrence and was indicated for adjuvant chemotherapy. He is currently taking imatinib and is being followed up for 6 months without recurrence. Although diagnosing GIST of small intestine can be difficult, GIST of small intestine with perforation is at high risk of recurrence and rezuires adjuvant chemotherapy. Emergency surgical diagnosis should not be hesitated.
Insights
A perforated jejunal gastrointestinal stromal tumor (GIST) in a 77-year-old man required emergency surgery. Early diagnosis and adjuvant imatinib therapy are crucial for managing this high-risk GIST to prevent recurrence.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Pathology
Background:
- Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms.
- Small intestinal GISTs can present with vague symptoms, complicating diagnosis.
- Perforation is a rare but serious complication of GIST, associated with high recurrence risk.
Purpose of the Study:
- To report a case of a perforated jejunal GIST.
- To highlight the diagnostic challenges and management of such cases.
- To emphasize the importance of prompt surgical intervention and adjuvant therapy.
Main Methods:
- Case presentation of a 77-year-old male with abdominal pain and melena.
- Diagnostic workup including abdominal CT scan.
- Emergency laparotomy with partial small intestine resection.
- Histopathological examination and immunohistochemistry (KIT, CD34).
Main Results:
- Diagnosis of a ruptured jejunal GIST (50 mm diameter) with perforation and intraperitoneal free air.
- Histopathology confirmed fistulous necrosis and GIST.
- Immunohistochemistry positive for KIT and CD34.
- Patient treated with adjuvant imatinib chemotherapy due to high-risk evaluation, with 6-month follow-up showing no recurrence.
Conclusions:
- Perforated small intestinal GIST is a high-risk condition requiring emergency surgery.
- Accurate diagnosis, including immunohistochemistry, is essential.
- Adjuvant chemotherapy, such as imatinib, is indicated for high-risk GISTs to prevent recurrence.
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