Perforated Jejunal Gastrointestinal Stromal Tumor(GIST) Presenting as Acute Abdomen: A Rare Presentation
Abstract
Gastrointestinal stromal tumors (GIST) are rare neoplasms of the gastrointestinal system. A case of 40 year old man having tense tender abdomen with obliterated liver dullness and shifting dullness was presented in emergency, it was further investigated on X rays, where pneumoperitoneum was found. This case was then decided to go for Laparatomy after routine investigations to further explore. On exploratory laparatomy, diffuse peritonitis with brown coloured fluid was observed. A 10 x 5 x 7 cm mass was found having an opening communicating with the gut lumen was present around 10 cm from the ligament of treitz. However, no adjacent structures, liver or parietal peritoneum seemed to be involved. Gross examination of the specimen revealed an outward bulging mass, which was centrally necrotic and contained hemorrhagic-necrotic material. On histo-pathological examination, features suggestive of gastrointestinal stromal tumor (GIST) with mixed spindle and epitheoid pattern was seen. Mitoses were slightly increased (<5/10' HPFs) leading to the conclusion of LOW GRADE GIST with tumor free margins of gut (R0 resection). So it was a case of Gastrointestinal stromal tumors (GIST), which is a rare medical presentation. So it was decided to report this case as a rare case presentation.
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Introduction
Gastrointestinal stromal tumors (GIST) are rare neoplasms of the gastrointestinal system accounting for 0.1-3% of all gastrointestinal malignancies. GIST most commonly occurs in the stomach (50-70%), small intestine (25-35%), colon and rectum (5-10%), mesentry (7%) and esophagus (<5%). Around 60% of the GIST are found to be symptomatic. Symptoms include abdominal pain (74%), abdominal mass (72%), gastrointestinal bleeding (44%) and gastrointestinal obstruction (44%)1,2.However, intestinal perforation as initial presentation of GIST is an extremely rare presentation.
Conclusion
GIST has a variety of abdominal symptoms, however, perforation as initial presentation is very rare. Whenever suspected, on exploratory laparotomy, R0 resection should be attempted and imatinib mesylate should be started on histopathological and IHC confirmation.