Spontaneous hemoperitoneum as a rare presentation of gastric lesions: Two case reports

Abstract

Introduction Spontaneous hemoperitoneum is a rare but life-threatening condition. Clinical presentation is usually nonspecific. The aim of this report is to document a rare clinical presentation of two different intramural stomach tumors. Clinical cases A 40-year-old patient with 24 h epigastric pain was admitted to the emergency, pale, with signs of peritoneal irritation. Computed tomography showed an hemoperitoneum with active bleeding in the posterior wall of the stomach. A wedge resection was performed. Histological report revealed a plexiform fibromyxoma (PF). The second case presents a 79-year-old patient with 24 h abdominal pain, fullness and dizziness, pale and with signs of peritoneal irritation. A voluminous exophytic lesion on gastric wall with active bleeding was diagnosed. Wedge resection was performed and histological report demonstrated a gastrointestinal stromal tumor (GIST). Discussion Imaging plays a role in the diagnosis of spontaneous hemoperitoneum, in elucidating a cause and detecting active hemorrhage. Tumor hemorrhage may be the first presentation of an underlying mass. The presence of a bleeding gastric mass of uncertain nature may result in a challenging situation for the surgeon, who is forced to perform a gastric resection without knowing the exact nature of the tumor and hence the extent of gastric resection required. To our knowledge, our case is the first of PF presenting as hemoperitoneum. Hemoperitoneum is rare as first presentation of GIST, with few cases reported in literature. Conclusion We report two extremely rare cases of spontaneous hemoperitoneum as first presentation of gastric tumor. For the diagnosis a high level of suspicion is required.

Spontaneous isolated gastric intramural hematoma combined with spontaneous superior mesenteric artery intermural hematoma: a rare case

“…We therefore considered this case to be an idiopathic hematoma. It is important to distinguish it from various submucosal tumors including gastrointestinal mesenchymal tumors (GISTs) because of the submucosal tumor-like appearance of the hematoma [ 18 ]. In previously published case reports, there have been confusing misclassifications in the diagnosis of intramural hematomas in the stomach.…”

An Unpropitious Surprise Post Vaginal Hysterectomy – A Case of Incidentally Discovered Extra-Gastrointestinal Stromal Tumour

“…2 The presence of a bleeding mass of uncertain nature may result in a challenging situation for the surgeon, who is forced to perform a resection without knowing the https://ijhhsfimaweb.info/index.php/IJHHS exact nature of the tumour and hence the extent of resection required. 9 The histopathologic variants include epithelioid, spindled, vacuolated, nested and myxoid. In this case, we encountered the pseudo-signet ring appearance of tumour cells, which is rare and can pose a diagnostic challenge.…”

A case of idiopathic gastric intramural hematoma diagnosed using contrast-enhanced ultrasonography and followed up with conservative treatment

“…This disease is most often seen in patients with underlying hemophilia or other hemorrhagic predisposition as well as in patients receiving anticoagulant therapy [2] . Because of the submucosal tumor-like appearance of the hematoma, it is important to distinguish it from various kinds of submucosal tumors, including gastrointestinal stromal tumors (GISTs) [3] . We herein report a case of an idiopathic gastric intramural hematoma diagnosed by ultrasonography (US) that was followed up with conservative treatment.…”