No abstract

A 60-year-old female presented to the Emergency room with complaints of diffuse lower abdominal pain for one day duration with three episodes of haematochezia over eight hours duration. On examination, she had pallor and tachycardia. On clinical examination of abdomen, there was tenderness, mild guarding, rebound tenderness and an ill defined mass in the right iliac fossa. On rectal examination, blood staining of digit was present. The laboratory tests showed haemoglobin of 8 gm% and leukocytosis 16000 cells/mm 3 . Chest and abdomen X-rays were normal. Ultrasound abdomen reported an ill defined mass in RIF with minimal free fluid and probe tenderness. CECT of abdomen demonstrated a peripheral enhancing, encapsulated abscess in RIF, in close contact with base of caecum and adjacent peritoneal inflammation, suggesting a sealed caecal perforation [Table/ Fig-1].abdomen was closed in layers.Pathological findings: Pathological examination revealed a 6 cm x 5 cm x 3 cm submucosal mass extending into the antimesenteric Gastrointestinal Stromal Tumours (GISTs) are tumours of the gut found mostly in stomach and small intestine. The complications are Gastrointestinal (GI) bleeding, obstruction, pain and rarely perforation. We are reporting an abnormal presentation of GIST masquerading as an acute abdomen with Right Iliac Fossa (RIF) mass in 60-year-old lady. Contrast Enhanced Computed Tomography (CECT) of abdomen revealed a peripherally enhancing encapsulated abscess in RIF in close contact with base of caecum and adjacent peritonitis suggesting caecal perforation. On laparotomy, a gangrenous perforated ileal GIST was identified along the antimesenteric border of ileum. Pathological examination confirmed the tumour to be a GIST of spindle cell type, further reiterated by immunohistochemistry. Our case report emphasizes, GIST as a rare and unusual differential diagnosis of RIF mass, and to have high degree of clinical suspicion when a similar situation is encountered in an emergency scenario, keeping in mind the poor outcome due to delay in appropriate management of the disease.