Unusual Presentation of a Gastrointestinal Stromal Tumor in a Small Intestine Diverticulum

Abstract

A 50-year-old female with no significant medical history initially presented to an urgent care center with symptoms of acute onset abdominal pain, nausea, and emesis. Chest and abdominal X-ray revealed free air under the diaphragm, prompting immediate transfer to the emergency department. Continued abdominal tenderness and pain were concerning for perforated viscus. The patient was transferred to the operating room, and diagnostic laparoscopy was performed. Inflammation and contamination were discovered in the right side of the abdomen and pelvis secondary to a small bowel (SB) perforation. Segmental SB resection revealed a perforated diverticulum. Pathological examination confirmed a diagnosis of gastrointestinal stromal tumor (GIST) at the perforated segment. On postoperative day 5, the patient was discharged home, and at 30-month follow-up, the patient continued to do well. Although rare, SB diverticula are commonly false (i.e., pseudodiverticula). The concomitant presence of a GIST in a true SB diverticulum presenting with perforation has not yet been reported.

Gastrointestinal stromal tumour: presenting as an ovarian cystadenoma

“…CD 117(c-kit) and DOG 1 are the most used markers for GIST diagnosis 1 6. However, in some cases, these markers may not be sufficient for a definitive diagnosis.…”

“…However, in some cases, these markers may not be sufficient for a definitive diagnosis. In this situation, additional markers such as SDHB, CD 34, smooth muscle actin and S100A4 may be used to help confirm the diagnosis 1 3 4…”

“…Gastrointestinal stromal tumours (GISTs) are frequent mesenchymal tumours of the gastrointestinal (GI) tract, which evolve from the so-called ‘pacemaker’ of the digestive system—the interstitial cells of Cajal 1 2. Men in their middle years tend to have them the most 2.…”

“…Inadvertently discovered during surgery or radiological examinations, GISTs are frequently identified as isolated lesions that might vary from less than 1 cm to 30 cm in size 2 3. Small-bowel GISTs are more frequently diagnosed when they are large and present with complications such as bowel obstruction, viscus perforation, bleeding and ulceration 1 2 5. They usually present as an abdominal mass and less commonly present as a pelvic mass that might mimic an ovarian adnexal tumour radiologically, especially when they compress atrophic adnexal structures in an elderly woman.…”

Multinodular gastro intestinal stromal tumor in small intestine with perforation and Meckel’s diverticulitis- An unusual presentation

“…9 Spontaneous perforation in Gastro Intestinal diverticulum is rarely being reported. 10 Till now, only 45 cases have been reported in literature with the incidence of perforation associated with a GIST. 9 Size of the tumor correlates with mitotic count.…”