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Okano H, Nakatsuka A, Ogura M, Mukai K, Nishimura A, Asakawa K, Baba Y, Murata T, Hirota S. Bleeding From a Ruptured, Extraluminally Growing Gastric Gastrointestinal Stromal Tumor Treated by Transcatheter Arterial Embolization: A Case Report. Cureus 2024; 16:e52394. [PMID: 38361680 PMCID: PMC10869128 DOI: 10.7759/cureus.52394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
A 49-year-old man with abdominal pain was referred to our hospital. Abdominal computed tomography showed an extraluminal tumor near the gastric anterior wall and intra-abdominal fluid collection. A ruptured intra-abdominal tumor was suspected, and emergency abdominal angiography was performed. Hemorrhage into the abdominal cavity was seen, and transcatheter arterial embolization (TAE) was performed, which stopped the bleeding. The tumor was surgically resected, and a diagnosis of an extraluminally growing gastric gastrointestinal stromal tumor was made. TAE should be considered for rare cases of extraluminally growing tumors with intra-abdominal hemorrhage.
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Affiliation(s)
- Hiroshi Okano
- Gastroenterology, Suzuka General Hospital, Suzuka, JPN
| | | | | | - Katsumi Mukai
- Gastroenterology, Suzuka General Hospital, Suzuka, JPN
| | | | | | | | | | - Seiichi Hirota
- Surgical Pathology, Hyogo Medical University School of Medicine, Nishinomiya, JPN
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Tada Y, Yamamoto M, Sawata S, Hara K, Sugesawa K, Ueshima C, Tanio A, Kihara K, Matsunaga T, Tokuyasu N, Takano S, Sakamoto T, Honjo S, Hasegawa T, Fujiwara Y. Ruptured Small Intestinal Stromal Tumor Causing Concurrent Gastrointestinal and Intra-Abdominal Hemorrhage: A Case Report. Yonago Acta Med 2021; 64:137-142. [PMID: 33642915 DOI: 10.33160/yam.2021.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/12/2021] [Indexed: 12/14/2022]
Abstract
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 intra-abdominal 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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Affiliation(s)
- Yoichiro Tada
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Manabu Yamamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Shohei Sawata
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Kazushi Hara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Ken Sugesawa
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Chihiro Ueshima
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Akimitsu Tanio
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Kyoichi Kihara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Naruo Tokuyasu
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Shuichi Takano
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Teruhisa Sakamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Soichiro Honjo
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Toshimichi Hasegawa
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
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Fukuda S, Fujiwara Y, Wakasa T, Inoue K, Kitani K, Ishikawa H, Tsujie M, Yukawa M, Ohta Y, Inoue M. Small, spontaneously ruptured gastrointestinal stromal tumor in the small intestine causing hemoperitoneum: A case report. Int J Surg Case Rep 2017; 36:64-68. [PMID: 28549261 PMCID: PMC5443905 DOI: 10.1016/j.ijscr.2017.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/04/2017] [Accepted: 05/14/2017] [Indexed: 12/26/2022] Open
Abstract
Hemoperitoneum is a rare and potentially life-threatening complication of GISTs. Even small GISTs in the small intestine can rupture and cause hemoperitoneum. Because of their high vascularity, ruptured GISTs can cause massive hemoperitoneum.
Introduction Gastrointestinal stromal tumors (GISTs) are clinically asymptomatic until they reach a significant size; therefore, GISTs that are 2 cm or less are typically asymptomatic. Patients with symptomatic GISTs typically present with abdominal pain, gastrointestinal bleeding, or a palpable mass but rarely present with hemoperitoneum. Presentation of case A 72-year-old Japanese man presented to us with acute onset abdominal pain. Physical examination showed peritoneal irritation in the lower abdomen. Findings of abdominal computed tomography were suggestive of hemoperitoneum; therefore, urgent surgery was performed. Approximately 1500 ml of blood in the abdominal cavity was removed. A small, ruptured mass was found in the middle of the small intestine, and partial resection of the small intestine, including the mass, was performed. The resected tumor was 2 cm in size and exhibited an exophytic growth pattern. Immunohistochemical staining revealed that the tumor was positive for KIT and CD34; therefore, a final diagnosis of GIST was made. Treatment with imatinib at 400 mg per day was started from postoperative month 1. The patient is doing well without recurrence 5 months after surgery. Discussion Even small GISTs in the small intestine can spontaneously rupture and cause hemoperitoneum. Moreover, when a patient presents with sudden abdominal pain and hemoperitoneum without an evident mass on imaging, clinicians should be aware of the possibility of bleeding from a small GIST in the small intestine. Conclusion We present an extremely rare case of a patient with a small, spontaneously ruptured GIST in the small intestine, resulting in hemoperitoneum.
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Affiliation(s)
- Shuichi Fukuda
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Nara, Japan.
| | - Yoshinori Fujiwara
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Nara, Japan.
| | - Tomoko Wakasa
- Department of Pathology, Kindai University Nara Hospital, Nara, Japan.
| | - Keisuke Inoue
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Nara, Japan.
| | - Kotaro Kitani
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Nara, Japan.
| | - Hajime Ishikawa
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Nara, Japan.
| | - Masanori Tsujie
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Nara, Japan.
| | - Masao Yukawa
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Nara, Japan.
| | - Yoshio Ohta
- Department of Pathology, Kindai University Nara Hospital, Nara, Japan.
| | - Masatoshi Inoue
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Nara, Japan.
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