Perforated gastrointestinal stromal tumor (GIST) in a true jejunal diverticulum in adulthood: report of a case

Abstract

A 61-year-old man was referred to us for investigation of acute abdominal pain. Computed tomography showed a 5.9 × 5.3 × 5.0 cm lump of food residue in the jejunum, and a large amount of free air and ascites around the liver and right paracolic gutter. He underwent emergency laparotomy for suspected peritonitis from perforation by a foreign body in the small intestine. We identified purulent exudate in the abdominal cavity and perforation of a jejunal cystic mass, attached ~40 cm from Treitz's ligament at the anti-mesenteric side of the jejunum. Based on a diagnosis of jejunal duplication with perforation, we resected that part of the small intestine and performed intra-abdominal drainage. Pathological findings confirmed the diagnosis of a perforated gastrointestinal stromal tumor (GIST) in a true jejunal diverticulum. Histopathological evidence suggests that intestinal pressure and/or hemorrhage can cause perforation in the background of a true jejunal diverticulum. To our knowledge, this is the first case report of a perforated GIST in a true jejunal diverticulum.

Spontaneous free perforation of the small intestine in adults

“…These include perforated Meckel's diverticulae [79] as well as jejunal [80] and ileal duplications [81] . These may be isolated congenital diverticulae that initially only appear for the first time in the elderly [82] .…”

“…These may be isolated congenital diverticulae that initially only appear for the first time in the elderly [82] . Interestingly, in several independent reports, gastrointestinal stromal tumors (GISTs) complicated the diverticulum or duplication and were responsible for a superimposed focal intestinal perforation [79][80][81] . A number of unusual mesenteric vascular causes have been described as a cause of small intestinal perforation.…”

Emergency Atypical Resection for Perforated Gastric Gist

“…It should be made a R0 resection with clear margins of 1 -2 cm preventing rupture of the tumor [10] [11]. Lymphadenectomy is not required.…”

Perforated gastrointestinal stromal tumor in the small intestine: A rare case of Torricelli-Bernoulli sign

“…We encountered a patient who had perforated intestinal GIST associated with the T-B sign. We performed a PubMed search for previous reports about perforated intestinal GIST used the keywords 'perforated GIST', 'free air', and 'small intestine', and we identified 6 articles (12)(13)(14)(15)(16)(17). One of these articles reported a mass with an air/fluid level, but did not mention the T-B sign (17).…”