Case Report: Jejunal gastrointestinal stromal tumour, a rare tumour, with a challenging diagnosis and a successful treatment

Abstract

Gastrointestinal stromal tumours (GISTs) are rare. GISTs comprise 0.2% of gastrointestinal tumours and only 0.04% of small intestinal tumours. Jejunal GISTs are the rarest subtype. Only 10–30% progress to malignancy [Choi (Response evaluation of gastrointestinal stromal tumors. Oncologist 2008;13:4–7)]. We present a 70-year-old male, with multiple co-morbidities, who had extensive investigations over 5 years for vague abdominal pain. All investigations were normal. He presented with symptoms and signs of small bowel obstruction (SBO), confirmed on a computed tomography scan and demonstrated to be secondary to lesion-induced intussusception. The patient had emergency small bowel resection, was discharged after 4 days and remains well. This case report highlights the rarity of jejunal GISTs and, as extensive initial investigation yielded all false-negative results, indicates the difficulty in diagnosing jejunal GISTs. Adhesions are the commonest cause of SBO in patients with previous abdominal surgery, followed by newly diagnosed malignancies [Beardsley et al. (Small bowel obstruction in the virgin abdomen: the need for a mandatory laparotomy explored. Am J Surg 2014;208:243–8)]. Consequently, in patients with a virgin abdomen, underlying tumours should be considered.

Gastrointestinal stromal tumor presenting as ileo-ileal intussusception: a rare case report

“…It is used as adjuvant therapy in high risk diseases. 2,3 Intussusception is the telescoping of one portion of intestine into the other; invariably it is the proximal into the distal. It is most common in children where it is usually idiopathic.…”

“…Gastrointestinal stromal tumors (GISTs) arise from the interstitial cells of Cajal in the mesenchymal tissue and constitute less than 3% of all gastrointestinal malignant neoplasms and represent only 20% of small-bowel malignant neoplasms. 1,2 The clinical presentation of GISTs is highly variable depending on their size, location and presence of mucosal ulceration. Abdominal pain and gastrointestinal bleeding(when mucosal ulceration is present) are the most common symptoms or signs.…”

“…3,4 Very few cases of small bowel intussusceptions from stromal tumor in adults have been described in medical literature. [1][2][3][4][5] Intussusception is rather infrequent in adults, accounting for 0.1% of all surgical admissions and 1-5% of mechanical bowel obstructions. GISTs presenting as intussusception is very rare especially since GISTs grow in an extraluminal fashion.…”

Laparoscopic Management of Strangulated Broad Ligament Hernia

“…7 The causes for small bowel obstruction in a virgin abdomen are internal hernias, congenital bands, bowel tumors, Meckel's diverticulum, and luminal obstruction by bezoars or foreign bodies. [8][9][10] Most of these are managed by surgery after variable periods of conservative treatment. The most common mode of presentation for BLH consists of abdominal pain, particularly "colicky abdominal pain", 11 and nausea and/or vomiting.…”

Small Bowel GIST: Clinical Presentation as Intussusception and Obscure Bleeding

“…GISTs may occur anywhere along gastrointestinal tract, but most commonly arise in the stomach (40–60%) and jejunum/ileum (25–30%). 1 , 2 …”