Primary Small Bowel GIST Presenting as a Life-Threatening Emergency: A Report of Two Cases

Abstract

Gastrointestinal stromal tumor (GIST) is a rare stromal neoplasm, which represents the most common mesenchymal tumor of the gastrointestinal tract. It is characterized by indolent clinical symptoms, although it can present as a life-threatening emergency. Herein, we present two cases of primary small bowel GIST treated at our department. A 68-year-old female patient presented to our emergency department with a diffuse abdominal pain of acute onset. Imaging studies revealed a mass at proximal jejunum, with a nearby free air and fluid. At surgery, a mass of 9 cm was found at proximal jejunum, 3 cm distal to the treitz ligament, with perforation on the lateral wall of the mass. En bloc resection was performed. Pathology report was positive for gastrointestinal stromal tumor. A 70-year-old male patient presented to our emergency department with 3 days of dark tarry stool and few hours of hematochezia. Computed tomography angiography revealed a mass at the pelvis, with calcifications, attached to the distal ileum, with intraluminal blush of intravenous iodine. At surgery, a mass of 8 cm at the distal ileum was found. Resection of the mass along with a 20 cm of ileum was completed. Histopathology report was positive for malignant gastrointestinal stromal tumor.

Small bowel gastrointestinal stromal tumor presenting with involvement of the adjacent small bowel and hemoperitoneum case report

“…Sixty to seventy percent of GIST's are found in the stomach as the primary site, with the other twenty to thirty percent found in the small bowel, and less than ten percent from elsewhere in the GI tract [ 2 ]. They usually exhibit an endophytic growth pattern involving the muscularis mucosa or propria layers and very rarely show exophytic growth [ 5 ]. GIST's involving the small bowel, of a size greater than 5cm, have a high incidence of bleeding, as seen in our case with the patient having undergone workup multiple times at different hospitals for 6 years with no diagnosis [ 16 ].…”

“…In spite of rupture of the capsule and hemoperitoneum, no peritoneal or omental metastasis/seeding were seen in our case. After surgery, adjuvant therapy with imatinib mesylate has proven to be effective in decreasing recurrence [ 5 , 9 ].…”

“…A prognostic criterion proposed by the National Institutes of Health are used clinically which classify GIST's into very low, low, intermediate, and high risk for malignancy based on tumor size and mitotic rate [ Table 1 ] [ 9 ]. These tumors rarely invade lymph nodes and rather spread hematogenously to the liver, bone, and lung [ 2 , 5 ]. They also spread by direct extension to surrounding structures within the abdominal cavity such as the peritoneum [ 5 , 10 ].…”

“…However, 60–70% arise from the stomach, 20–30% from the small bowel, and less than 10% elsewhere in the GI tract or extraintestinal sites [ 3 ]. They usually have an endophytic growth pattern with the tumor arising from the muscularis mucosa or propria layers of the GI tract [ 5 ]. All of the following work is reported in line with SCARE criteria [ 19 ].…”

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).…”