An unusual and life-threatening presentation of a large GIST.
| Autor: | Saeidi N; Department of Surgery, Al-Adan Hospital, Kuwait. Electronic address: nosheen5297@gmail.com., AlAli Y; Department of Surgery, Al-Adan Hospital, Kuwait., Boushehry R; Department of Surgery, Al-Adan Hospital, Kuwait., Al Safi S; Department of Surgery, Al-Adan Hospital, Kuwait. |
|---|---|
| Jazyk: | angličtina |
| Zdroj: | International journal of surgery case reports [Int J Surg Case Rep] 2022 Oct; Vol. 99, pp. 107666. Date of Electronic Publication: 2022 Sep 17. |
| DOI: | 10.1016/j.ijscr.2022.107666 |
| Abstrakt: | Introduction: Gastrointestinal stromal tumours (GIST's) are rare tumours of the alimentary tract. They are often discovered incidentally during imaging or intra-operatively. In rare instances, they present acutely with life threatening gastrointestinal (GI) bleeding requiring emergency surgical intervention. Case Presentation: A 47-year-old gentleman, who is an ex-smoker with normal body mass index (BMI), presented with acute onset of epigastric pain, dizziness, and multiple episodes of melaena. The patient deteriorated rapidly and urgent endoscopy revealed active retrograde bleeding from beyond the duodenojejunal junction. Computed tomography angiography (CTA) suggested a highly vascular ileal exophytic mass resembling a GIST. Emergency exploratory laparotomy was conducted where hemostasis was achieved via segmental enterectomy of the mass that was unexpectedly jejunal in origin. During recovery, he encountered post-operative complications that were managed conservatively and eventually was discharged with a referral to the national cancer centre. Clinical Discussion: The clinical presentation of GIST is based on its size and location. Definitive diagnosis of GIST relies on histopathological findings although the clinical presentation and imaging, in particular CTA, can aid in its diagnosis. Management of GIST differs depending on the clinical presentation, size, location and whether metastasis is present. Surgical resection is the standard of treatment; however, Imatinib could be used for non-resectable tumours as well as in cases of recurrence, metastasis or as an adjuvant chemotherapy. Conclusion: It is important to acknowledge that small GISTs are often asymptomatic while larger ones may present with non-specific symptoms which can be misleading. This could potentially delay the diagnosis and thus treatment of GIST which can be detrimental in acute cases as illustrated here. It is important to have GIST as one of the differentials when faced with a patient presenting with non-specific GI symptoms. Competing Interests: Declaration of competing interest There are no conflicts of interest including any financial or personal relationships with other people or organisations or any work influencers. (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.) |
| Databáze: | MEDLINE |
| Externí odkaz: |
|