Small, spontaneously ruptured gastrointestinal stromal tumor in the small intestine causing hemoperitoneum: A case report

Fukuda, Shuichi; Fujiwara, Yoshinori; Wakasa, T.; Inoue, Kazuo; Kitani, Kotaro; Ishikawa, Hajime; Tsujie, Masanori; Yukawa, Masao; Ohta, Yoshihiro; Inoue, Masatoshi

doi:10.1016/j.ijscr.2017.05.019

Cited by 10 publications

(6 citation statements)

References 19 publications

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“…This is because the intra-abdominal cavity has a large volume, and it is difficult to stop the hemorrhage. Indeed, in the previous ruptured cases, there had a large amount of bleeding in the abdominal cavity, 11,12,15,16,19,21 however, in our patient, the intra-abdominal hemorrhage volume was small and the gastrointestinal hemorrhage volume was large. Though it is certain that the hemorrhage from the vessel damaged by the rupture was predominantly into the intestinal tract through the ulcer, it is unclear why the gastrointestinal hemorrhage mainly occurred, and why both hemorrhage occurred simultaneously.…”

Section: Discussionmentioning

confidence: 43%

“…7 Fukuda et al reported small GISTs of 2 cm in diameter in the small intestine rupturing and causing hemoperitoneum. 11 However, 13/15 ruptured GISTs in the previous report were > 5 cm in size, which is associated with a potential for rupture 8, 9, 11-23 (Table 2). Fukuda et al's patient with hemorrhage related to a tumor < 5 cm in diameter was remarkably rare considering that tumor growth increased intratumoral pressure and led to rupture causing intra-abdominal hemorrhage.…”

Section: Discussionmentioning

confidence: 86%

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Ruptured Small Intestinal Stromal Tumor Causing Concurrent Gastrointestinal and Intra-Abdominal Hemorrhage: A Case Report

et al. 2021

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Gastrointestinal stromal tumors (GISTs) originate from mesenchymal cells throughout the gastrointestinal tract. A common symptom is gastrointestinal hemorrhage; intra-abdominal hemorrhage is relatively rare. There are few reports of GIST presenting with both types of hemorrhage concurrently. A 77-year-old man was admitted to our hospital because of melena and anemia (Hb: 4.7 g/dL). Computed tomography revealed a small bowel tumor and high-density fluid in both the small intestine and the pelvic floor. We diagnosed a small intestinal tumor with concurrent gastrointestinal and intraabdominal hemorrhage, and performed emergency surgery. The tumor arose from the small intestine and was ruptured. We found hemorrhage in the pelvic cavity and performed partial small intestine resection. Pathological findings revealed that the tumor was positive for c-Kit protein and was diagnosed as GIST. The patient was discharged from the hospital on postoperative day 9 and received imatinib 1 month postoperatively. We experienced a very rare case of ruptured GIST originating from the small intestine associated with both gastrointestinal and intra-abdominal hemorrhage. We also reviewed the relevant literature.

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Section: Discussionmentioning

confidence: 43%

Section: Discussionmentioning

confidence: 86%

Ruptured Small Intestinal Stromal Tumor Causing Concurrent Gastrointestinal and Intra-Abdominal Hemorrhage: A Case Report

et al. 2021

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“…Tumor bleeding is a diagnostic hallmark of GIST. Gastrointestinal bleeding and intraperitoneal bleeding have been reported, and tumor bleeding also triggered the diagnosis in this case [ 17 , 18 ]. In the present case, it could not be established with certainty whether chemotherapy (imatinib) was the only cause of the bleeding, or whether the bleeding would have occurred anyway because of nature of the tumor (GIST).…”

Section: Discussionmentioning

confidence: 95%

A Case of Liver Metastasis from Small Intestinal Gastrointestinal Stromal Tumor 25 Years after Surgery including Autopsy Findings

Takano

Yamawaki

Noda

et al. 2021

Case Reports in Gastrointestinal Medicine

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Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor in the digestive tract. Recurrences may occur even after radical resection; however, recurrence later than 10 years after surgery is rare. We report a case of GIST with recurrence of liver metastasis 25 years after surgery. A 56-year-old man complained of sudden epigastric pain and was transferred to the emergency department. He had undergone partial resection of the small intestine for leiomyosarcoma 25 years previously. Abdominal computed tomography showed multiple liver tumors with massive hemorrhage. Ultrasound-guided percutaneous biopsy was performed for the 15-mm hepatic tumor in segment 2. Pathological findings revealed proliferation of spindle-shaped atypical cells, and immunostaining for c-kit and CD34 was both positive; the patient was therefore diagnosed with GIST. He then underwent chemotherapy for 7 years but died of multiple organ failure due to GIST. Autopsy revealed GIST occupying the entire liver with peritoneal dissemination, and minute lung metastases that could not be identified by CT were also detected. This case is interesting in considering the recurrence of GIST, and we will report it together with the literature review.

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“…Occasionally, the patient can develop symptoms of bloating or obstruction due to mass effect. Rarely, GISTs can present with massive gastrointestinal bleeding, perforated viscus, or spontaneous hemoperitoneum [5,6].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Hemoperitoneum From a Ruptured Gastrointestinal Stromal Tumor

Shively

Ebersbacher

Walsh

et al. 2020

Cureus

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This is a case report of a ruptured gastrointestinal stromal tumor (GIST) presenting as spontaneous hemoperitoneum. The patient was a 63-year-old female with a past medical history of hypertension and ulcerative colitis who presented to the emergency department with worsening epigastric pain. The patient denied history of trauma, previous surgeries, or forceful vomiting. She was not on anticoagulation. Vital signs at presentation were stable. A CT scan of abdomen/pelvis revealed a large amount of fluid in the upper abdomen with high attenuation material adjacent to the greater curvature of the stomach concerning for hemoperitoneum. Diagnostic laparoscopy revealed a significant amount of blood along the upper abdominal viscera. The procedure was converted to an upper midline laparotomy after identifying a necrotic, extremely friable 7 x 6 x 3 cm pedunculated mass with active hemorrhage on the posterior aspect of the greater curvature. A wedge resection was performed to remove the mass with grossly negative margins. An intraoperative frozen section revealed a stromal tumor with spindle cells. Final pathology revealed a pT3N0M0 stromal tumor with histologic spindle cells and a high mitotic rate (24/5 mm 2) consistent with a high-grade GIST. Given tumor rupture at presentation, the patient was started on imatinib therapy for a minimum duration of three years. GISTs are often asymptomatic or cause mild abdominal pain or GI bleeding. Rarely, an exophytic GIST may rupture leading to intraperitoneal bleeding. Surgical resection with negative margins is the mainstay of treatment although patients presenting with tumor rupture are at higher risk of dissemination and recurrence.

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Small, spontaneously ruptured gastrointestinal stromal tumor in the small intestine causing hemoperitoneum: A case report

Abstract: Graphical abstract

Cited by 10 publications

References 19 publications

Ruptured Small Intestinal Stromal Tumor Causing Concurrent Gastrointestinal and Intra-Abdominal Hemorrhage: A Case Report

Ruptured Small Intestinal Stromal Tumor Causing Concurrent Gastrointestinal and Intra-Abdominal Hemorrhage: A Case Report

A Case of Liver Metastasis from Small Intestinal Gastrointestinal Stromal Tumor 25 Years after Surgery including Autopsy Findings

Spontaneous Hemoperitoneum From a Ruptured Gastrointestinal Stromal Tumor

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