Gastroduodenal intussusception caused by gastric gastrointestinal stromal tumor: A case report and review of the literature

Abstract

BACKGROUND Gastric gastrointestinal stromal tumor (GIST) is the most common etiology of gastroduodenal intussusception. Although gastroduodenal intussusception caused by gastric GIST is mostly treated by surgical resection, the first case of gastroduodenal intussusception caused by gastric GIST was treated by endoscopic submucosal dissection (ESD) in Japan in 2017. CASE SUMMARY An 84-year-old woman presented with symptoms of postprandial fullness with nausea and occasional vomiting for a month. Initially, she visited a local clinic for help, where abdominal sonography revealed a space-occupying lesion around the liver, so she was referred to our hospital for further confirmation. Abdominal sonography was repeated, which revealed a mass with an alternating concentric echogenic lesion. Esophagogastroduodenoscopy (EGD) was performed under the initial impression of gastric cancer with central necrosis and showed a tortuous distortion of gastric folds down from the lesser curvature side to the duodenal bulb with stenosis of the gastric outlet. EGD was barely passed through to the 2nd portion of the duodenum and a friable ulcerated mass was found. Several differential diagnoses were suspected, including gastroduodenal intussusception, gastric cancer invasion to the duodenum, or pancreatic cancer with adherence to the gastric antrum and duodenum. Abdominal computed tomography for further evaluation was arranged and showed gastroduodenal intussusception with a long stalk polypoid mass 5.9 cm in the duodenal bulb. Under the impression of gastroduodenal intussusception, ESD was performed at the base of the gastroduodenal intussusception; unfortunately, a gastric perforation was found after complete resection was accomplished, so gastrorrhaphy was performed for the perforation and retrieval of the huge polypoid lesion. The gastric tumor was pathologically proved to be a GIST. After the operation, there was no digestive disturbance and the patient was discharged uneventfully on the 10th day following the operation. CONCLUSION We present the second case of gastroduodenal intussusception caused by GIST treated by ESD. It is also the first case report of gastroduodenal intussusception by GIST in Taiwan, and endoscopic reduction or resection is an alternative treatment for elderly patients who are not candidates for surgery.

Gastroduodenal intussusception caused by gastric gastrointestinal stromal tumor in adults: a case report and literature review

“…The treatment of gastroduodenal intussusception caused by gastric GIST mainly includes surgical resection and endoscopic treatment. Twenty-two previous cases 3 – 5 , 15 – 33 were treated by surgical resection and only two cases 11 , 14 were treated by endoscopic submucosal dissection (ESD). Notably, 12 cases underwent laparoscopic surgery, but no studies have reported the use of a robotic approach.…”

“…Endoscopic reduction may be an alternative option for patients who are unsuitable for resection, such as elderly patients who are not candidates for surgery or general anesthesia. 11 , 14 …”

“…12,13 We identified 43 reported cases of gastroduodenal intussusception caused by gastric tumors in adults in the literature (PubMed), including 24 cases of gastric GIST. [3][4][5]11,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] The clinical characteristics of these previous cases and the current case are presented in Table 1. There were 9 men and 15 women, ranging from 23 to 95 years of age.…”

“…Hsieh et al. 11 reviewed the relevant literature regarding gastroduodenal intussusception within the past 20 years and found that gastric GIST was the most common etiology, accounting for more than half of these cases in adults. Here, we report a case of gastroduodenal intussusception caused by gastric GIST in an 85-year-old man.…”

“…1,2 Case reports of gastroduodenal intussusception caused by gastric tumors, such as gastric gastrointestinal stromal tumor (GIST), [3][4][5] gastric carcinoma, 6 gastric lipoma, 7,8 gastric schwannoma, 9 and gastric leiomyoma, 10 are uncommon. Hsieh et al 11 reviewed the relevant literature regarding gastroduodenal intussusception within the past 20 years and found that gastric GIST was the most common etiology, accounting for more than half of these cases in adults. Here, we report a case of gastroduodenal intussusception caused by gastric GIST in an 85-year-old man.…”