A Spontaneously Ruptured Gastric Stromal Tumor Presenting as Generalized Peritonitis: Report of a Case

Abstract

Among the diverse clinical presentations of gastrointestinal stromal tumor (GIST), spontaneous rupture with peritonitis is extremely rare. We report herein the unusual case of a 75-year-old man found to have a spontaneously ruptured gastric stromal tumor after presenting with generalized peritonitis. The patient was brought to the emergency department of our hospital by ambulance, with generalized severe abdominal pain. On examination, his abdomen was extensively distended with generalized severe rebound tenderness. Abdominal computed tomography scan showed a giant mass arising from the anterior gastric wall with an irregular internal low-density area and a small amount of ascites. An emergency laparotomy revealed a ruptured gastric tumor with dissemination of its necrotic tissue throughout the peritoneal cavity. The tumor was excised together with normal gastric tissue around its base. The tumor, which was 15 x 11 x 4.4cm in size, had a coarse laceration over its well-capsulated smooth serosal surface with massive necrosis and clotted blood inside. Immunohistochemical examination revealed positive reactivity to C-kit protein, which was consistent with the newly introduced diagnostic criteria of GIST. The patient had an uneventful postoperative course and remains well.

Emergency Pylorus-Preserving Pancreatoduodenectomy Followed by Second-Stage Pancreatojejunostomy for a Gastrointestinal Stromal Tumor of the Duodenum with an Intratumoral Gas Figure: Report of a Case

“…Although we found some reports on GIST treated by PD in the English literature, none involved emergency operations; 14 however, emergency PD may be indicated for some GISTs, depending on their size and location, because of the risk of peritonitis if they bleed or burst. 7,8 …”

Spontaneous rupture of a sigmoid colon gastrointestinal stromal tumor manifesting as pneumoretroperitoneum with localized peritonitis: Report of a case

“…[10][11][12][13][14][15][16][17][18][19][20][21] In all cases, the tumor size was >5 cm, 12 of the 15 patients were older than 60 years, and the male-tofemale ratio was 2 : 1. Seven GISTs arose from the stomach 10,11,13,15,19,21 and four from the small intestine. [12][13][14]20 One case each originated from the mesocolon, 16 esophagus, 17 and greater omentum.…”

A Spontaneously Ruptured Gastric Stromal Tumor with Cystic Degeneration Presenting as Hemoperitoneum: A Case Report

“…Immunohistochemical analysis of the tumor from our patient showed positive staining for CD34 and c-kit. In our review of the literature on ruptured GISTs, we were able to find only two other similar case reports (7,8); one case was an 83-yr-old patient presenting with intraperitoneal hemorrhage and hypovolemic shock who was successfully treated by a total gastrectomy. However, c-kit expression was not investigated in this case.…”