A gastrointestinal stromal tumor found in perforated Meckel’s diverticulum

Abstract

BackgroundMeckel’s diverticulum is the most common anomaly of the gastrointestinal tract. It is usually asymptomatic, but approximately 4 % present with complications such as bleeding, intestinal obstruction, and inflammation, while perforation is rare. Carcinoid or gastrointestinal stromal tumors are occasionally found in the resected specimens of Meckel’s diverticulum, particularly in the context of perforation.Case presentationA 62-year-old male with a recent history of admission and evaluation for hematochezia presented with abdominal pain. His physical examination was consistent with peritonitis. Results of laboratory testing were significant for white blood cell count of 32,000/μL. CT scan of the abdomen revealed pneumoperitoneum. During the exploratory laparotomy, perforated Meckel’s diverticulum was encountered and segmental bowel resection was performed. Histological examination findings were compatible with gastrointestinal stromal tumor within Meckel’s diverticulum.ConclusionsWhile gastrointestinal stromal tumor is a rare finding in Meckel’s diverticula, the potential for the coexistence of this and other tumors suggests that segmental resection of the small bowel should be considered in the treatment of perforated Meckel’s diverticulum.

Unusual Presentation of a Gastrointestinal Stromal Tumor in a Small Intestine Diverticulum

“…According to our literature review, this is the first case presentation of a GIST perforating through a diverticular structure within the terminal ileum, producing the unique symptoms observed in the patient. GISTs in other diverticular structures, such as Meckel's diverticulum, have been reported several times [ 8 , 9 ]. The mechanisms surrounding perforation of the GI wall are not fully understood.…”

“…A popular theory involves neoplastic cells replacing the muscularis propria of the gut wall, resulting in a fragile diverticular structure [ 20 ]. Other possible explanations for perforation include necrosis of tumor cells and increased luminal pressure due to intestinal obstruction by the tumor [ 9 ].…”

“…About 97% of GISTs are sporadic tumors, and about 20% of affected patients present with overt metastasis at diagnosis [ 6 , 7 ]. GISTs have been reported in unusual abdominal locations including the Meckel's diverticulum [ 8 , 9 ]. GI perforation at the site of the GIST is rare but has been reported [ 9 , 10 ].…”

“…GISTs have been reported in unusual abdominal locations including the Meckel's diverticulum [ 8 , 9 ]. GI perforation at the site of the GIST is rare but has been reported [ 9 , 10 ]. We report a rare case presentation of a GIST as a perforated diverticular structure in the terminal ileum in an adult female patient with acute onset abdominal pain.…”

Gastrointestinal stromal tumor in perforated Meckel’s diverticulum: a case report and literature review

“…In the review, almost all of the patients required small bowel resection. Since 2013, seven patients underwent imatinib chemotherapy after their operation [19][20][21][22][23][24][25]. The tumors ranged in longitudinal length from 1 to 14 cm.…”