WITHDRAWN: Diagnostic and Therapeutic Challenges in The Management of Acute Massive Overt Bleeding of Jejunal Gastrointestinal Stromal Tumours: Case Series

Abstract

Introduction: Jejunal Gastro-Intestinal Stromal Tumours (GIST) are rare mesenchymal tumours. Acute massive overt bleeding from jejunal GIST are very rare and poses both diagnostic and therapeutic challenges in emergent conditions. Methods A case series with retrospective analysis of prospectively maintained database of patients presenting with acute massive overt bleeding secondary to histologically proven jejunal GIST was done. Clinical characteristics, endoscopic and imaging diagnostic features, histological findings, surgical procedures and outcomes in these patients were studied. Results Three patients were included in this case series. Mean age of presentation was 49.0 years with two male and one female patient. All three patients presented with melena and hemodynamic instability, resuscitated with adequate blood transfusions. Routine endoscopic assessment were inconclusive. Multiphasic Computed Tomographic Angiography (CTA) revealed hypodense hypervascular mass in jejunum in all three patients. One patient was unresponsive to blood transfusion and underwent emergency exploratory laparotomy. One patient underwent laparoscopic resection and reconstruction. Mean length of hospital stay was 5.3 days. Histopathological examination confirmed Jejunal GIST in all three patients with microscopically negative resection margins. Two patients were disease free till 18 months follow up and the one patient lost to follow up after 1 year. Conclusion Multiphasic CTA is a single step diagnostic tool for localisation of bleed and assessment of tumour characteristics in emergent conditions. Surgical resection is the mainstay of treatment for both control of bleed and to provide oncologically clear resection margins.