Intramural gastric hematoma imitating a gastrointestinal stromal tumor – case report and literature review

Abstract

The article presents a case report of a patient with an intramural gastric hematoma. Diagnostic examinations were suggestive of a suspected gastrointestinal stromal tumor Normal image was observed in gastroscopic examination while abdominal CT scan revealed a nodular lesion along the greater curvature of the stomach extending from the posterior wall and adjoining the pancreas and the spleen. The patient was qualified for surgical treatment. Laparotomy was performed followed by total gastric resection and Roux-en-Y reconstruction of the gastrointestinal tract. Post-operative histopathological examination revealed the presence of an extensive hematoma penetrating the perigastric fat tissue along with numerous hemosiderinophages and segmental indicators of formation of inflammatory granulation tissue suggestive of a chronic nature of the lesion. Immunohistochemical GIST assays (CD117, DOG-1, CD34, CD31, SMA, S-100, CKAE1/AE3, Ki-67) were negative. No complications were observed in the post-operative course. Patient is subject to continued follow-up and observation. Follow-up gastroscopy and abdominal CT scan performed 6 months after the surgery revealed an unremarkable image.

Gastric Mass: Intramural Hematoma

“…Symptomatic intra-mural gastric hematomas are exceedingly rare, with fewer than 40 other cases available in the literature and fewer than 15 treated with surgery [ 8 , 9 ]. Because of their rarity, treatment recommendations are not standardized [ 8 ].…”

“…Symptomatic intra-mural gastric hematomas are exceedingly rare, with fewer than 40 other cases available in the literature and fewer than 15 treated with surgery [ 8 , 9 ]. Because of their rarity, treatment recommendations are not standardized [ 8 ]. The most common causes of intramural gastric hematoma include coagulopathy (53%), aneurysm (15%), PUD (11%), spontaneous (11%), and miscellaneous other (7%).…”

Gastric intramural hematoma subsequent to thoracic aortic dissection: Case report and literature review

“…Usually, there is gastric luminal narrowing and a submucosal bright-red or dark-red mass, depending on the examination's timing, sometimes, with the presence of active mucosal bleeding [ 4 ]. EUS is also a useful method to assess lymph nodal status and the depth of the mass, providing cytological and histological material, to differentiate from the subephitelial tumors/GISTs [ 3 , 25 ]. In this case, EUS was undertaken during outpatient follow-up to assess regression of the hematoma and perform EUS-FNA if needed.…”

“…As exposed in the current review, 50.8% of the sample underwent surgical exploration. It is especially recommended in cases with unclear diagnosis, suspected complications, ongoing bleeding and failure of minimally invasive therapy [ 5 , 25 , 28 , 29 ]. The decision to operate emergently is largely driven by the clinical scenario [ 6 ].…”

Spontaneous Gastric Intramural Hematoma: Case Report and Literature Review

“…The rarity of this disease especially with the absence of a trigger can make the diagnosis of spontaneous gastric intramural hematoma (SGIH) very challenging. To our knowledge, only six cases of SGIH are reported in the literature, of which four were managed surgically and two conservatively [ 4 - 9 ]. Herein we present a rare case of a previously healthy 28-year-old male patient who underwent laparotomy for a bleeding gastric mass that turned out to be an SGIH.…”