Successful Laparoscopic Sleeve Gastrectomy in Emergency for a Gastric Gastrointestinal Stomal Tumor (GIST) with Acute Bleeding: A Case Report

Abstract

Patient: Male, 67Final Diagnosis: Gastric GISTSymptoms: Chest pain • hematemesis • melena • shockMedication: —Clinical Procedure: Laparoscopic sleeve gastrectomySpecialty: SurgeryObjective:Management of emergency careBackground:Gastrointestinal stomal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, and the stomach is the most commonly involved organ. Complete surgical resection with negative margins is the primary and only potentially curative treatment. Surgeon experience with minimally invasive gastric resections in addition to the tumor size and site has to be considered in the choice of laparoscopic or open surgical approach in order to remove the lesion.Case Report:A 67-year-old male patient with an history of gastric ulcer presented 2 days after an esophagogastroduodenoscopy with an incidental finding of a 30-mm gastric submucosal lesion that was not histologically defined (biopsies were taken), chest pain in association with hematemesis, and melena. An initial attempt to achieve endoscopic hemostasis with epinephrine injection was followed by the recurrence of the gastric bleeding until the presentation of hemorrhagic shock. An emergent laparoscopic sleeve gastrectomy was then performed for hemorrhage control. There were no intra- or postoperative major complications and the histological findings led to the diagnosis of a gastrointestinal stromal tumor (GIST).Conclusions:Laparoscopic sleeve gastrectomy is a bariatric surgical treatment of morbid obesity. This report describes the application of a bariatric procedure in a life-threatening situation and illustrates how safe and effective it can be when performed by surgeons with excellent laparoscopic skills.

A bleeding GIST in pandemic times, a cooperative approach to a delayed complication, a case report

“…GISTS are usually asymptomatic and found incidentally on CT scans, endoscopy, or other surgical procedures [ 3 , 4 ]. Nonetheless, they can present with a broad range of gastrointestinal symptoms according to their location or size, including abdominal pain, satiety, nausea, or abdominal mass [ 1 ].…”

“…In more unusual occasions, GISTs can perforate the bowel wall causing peritonitis and acute abdomen [ 1 , 2 ]. Gastrointestinal bleeding is the most common symptom of gastric GIST (54%), and in a few cases, the gastric GIST's acute bleeding is so severe that it may require embolization or surgical resection [ 4 , 5 ]. Cancer-related bleeding account for only 5% of all the causes of upper gastrointestinal bleeding; gastric GISTs tend to bleed when they are larger than 5 cm and are Ki-67 positive [ [4] , [5] , [6] ].…”

“…Gastrointestinal bleeding is the most common symptom of gastric GIST (54%), and in a few cases, the gastric GIST's acute bleeding is so severe that it may require embolization or surgical resection [ 4 , 5 ]. Cancer-related bleeding account for only 5% of all the causes of upper gastrointestinal bleeding; gastric GISTs tend to bleed when they are larger than 5 cm and are Ki-67 positive [ [4] , [5] , [6] ]. It is believed that as tumors grow, bleeding could be caused by a mucosal break or ulceration; Ki-67 also plays a role as it is a biomarker of tumor proliferation [ 5 ].…”

“…It is believed that as tumors grow, bleeding could be caused by a mucosal break or ulceration; Ki-67 also plays a role as it is a biomarker of tumor proliferation [ 5 ]. If Ki-67 is present and the tumor is more significant than 5 cm, surgical resection should be considered promptly [ 1 , 4 ].…”

“…When these tumors present with symptoms, they are generally vague and non-specific [ 1 ]. Upper gastrointestinal bleeding is the most common symptom when diagnosing a GIST; however, it is usually self-controlled or found incidentally in a positive fecal occult blood test [ 1 , 4 ]. On rare occasions, the tumor can cause severe bleeding leading to hypotension that must be controlled using surgery or endoscopic techniques [ 1 , 5 ].…”