Small duodenal gastrointestinal stromal tumor presenting with acute bleeding misdiagnosed as hemobilia: Two case reports

Abstract

Abstract. Only 3-5% of gastrointestinal stromal tumors (GISTs) are located in the duodenum. They are associated with an increased risk of fatal gastrointestinal bleeding, which is a primary manifestation. A small GIST (less than 2 cm in size) is easily confused with a duodenal papilla. In the 2 cases presented in this study, endoscopic examination alone resulted in a misdiagnoses of hemobilia. To the best of our knowledge, this is the first case report of this type in the literature. Patient 1 is a 66-year-old male who was admitted to The Second Affiliated Hospital of Dalian Medical University with syncope. Emergent upper gastrointestinal endoscopy identified bleeding from what appeared to be a duodenal papilla, and the patient was diagnosed with hemobilia. However, the angiography did not support this result. To save the patient's life, an exploratory laparotomy was conducted. We identified a small tumor in the descending part of the duodenum and a wedge resection was successfully conducted. The final diagnosis was duodenal GIST with no further risk to the patient. Patient 2 is a 71-year-old female who was admitted to the hospital diagnosed with hemobilia. The patient underwent a barium swallow examination and a contrast-enhanced computed tomography (CT) scan, in which a tumor on the descending part of the duodenum was identified. Patient 2 also underwent a wedge resection. The final diagnosis was duodenal GIST with no further risk to the patient. Gastroscopy may be a useful procedure for duodenal GIST diagnosis; however, the endoscopic findings may be confused with hemobilia when the tumor diameter is less than 2 cm in size and heavily accompanied with blood clots. A barium swallow examination and contrast-enhanced CT may prevent a misdiagnosis of hemobilia.

Surgical treatment of gastrointestinal stromal tumors of the duodenum: a literature review

“…Wall et al reported a rare case with duodenal-jejunal intussusception (23). Lin et al described two cases with bleeding small dGISTs (<2 cm) initially misdiagnosed as hemobilia (123). A case mimicking refractory peptic ulcer treated for 8 years was also described (76), even hypercalcemia due to elevated serum calcitriol in metastatic disease as well (124).…”

Interventional digital subtraction angiography for small bowel gastrointestinal stromal tumors with bleeding

“…In addition, two reasons that the small bowel GISTs were relatively smaller compared with previous reports [1,10,11,14] include tumor bleeding and the timely use of the DSA procedure. Furthermore, to our knowledge, this article presents the largest DSA series of small bowel GISTs to date [13,[17][18][19][20] . Based on our DSA findings, it is not difficult to detect and make a preoperative diagnosis and to locate small bowel GISTs.…”

Tumores Del Estroma Gastrointestinal (Gist) Del Duodeno: Presentación Clínica, Estudio Diagnóstico Y Tratamiento Actual

“…Los GIST se manifiestan clínicamente alrededor de los 60 años de edad, siendo más frecuentes en pacientes masculinos (68% a 80%) [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] . La localización duodenal no es común con una prevalencia de 5% 7,18 . en series de casos de GIST localizados específicamente en el duodeno la incidencia varía entre 6% y 29% 16,17,19 .…”

“…Los GIST duodenales son relativamente infrecuentes (prevalencia 5% a 7%), sin embargo, representan 30% de todos los tumores duodenales primarios 7 . La mayoría de las publicaciones sobre GIST duodenales son reportes de casos o series de casos [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] . Consecuentemente, las manifestaciones clínicas, estudio y tratamiento constituyen materia de controversia.…”