Multiple jejunal gastrointestinal stromal tumors and Neurofibromatosis type 1: A rare association

Hemorrhagic Shock Due to a Gastrointestinal Stromal Tumor in a Patient With Neurofibromatosis Type 1: A Case Report

Gastrointestinal stromal tumors (GISTs), though rare, are associated with neurofibromatosis (NF) type 1 and may cause significant gastrointestinal bleeding. A 42-year-old male with NF1 presented with severe hematochezia and underwent initial non-contrast CT, which was negative for abnormalities. Subsequent endoscopies and PillCam studies also revealed no clear bleeding source. Due to persistent bleeding and hemodynamic instability, a contrast-enhanced CT was eventually performed, revealing a hyper-enhancing mass in the proximal ileum. Emergent surgical exploration identified a 1.5-cm jejunal GIST, which was resected successfully, stabilizing the patient who was discharged without the need for adjuvant therapy. This case highlights the importance of early contrast-enhanced imaging in NF1 patients presenting with acute bleeding to facilitate timely diagnosis, reduce hospital resource utilization, and avoid unnecessary invasive procedures.

Laparoscopic retroperitoneal resection of the duodenal gastrointestinal stromal tumors in neurofibromatosis type 1; Case Report and literature review

Background

Neurofibromatosis type 1, also known as NF1, is a disorder that is passed down in an autosomal dominant manner. It manifests in a wide variety of tumors and affects several organ systems. It is expected that those carrying the NF1 gene will develop a rare mesenchymal tumor known as a gastrointestinal stromal tumor (GIST) more than general population.

Case report

This research discusses a 42-year-old female patient with NF1 who was identified with a duodenal GIST but clinically and radiographically misinterpreted as having a retroperitoneal neurofibroma. She had minimally invasive retroperitoneal laparoscopic surgery to remove the tumor and primary anastomosis of the affected duodenal wall. A spindle cell GIST was entirely excised during surgery, as indicated by the pathologist. As a consequence of dialogue at a multidisciplinary team meeting, the patient was discharged from the hospital on the fourth postoperative day and is presently undergoing regular clinical follow-up.

Conclusion

Anatomically problematic sites, such as the duodenal GIST in NF1 patients, can be treated safely with the laparoscopic retroperitoneal approach even when retroperitoneal neoplasia arises from the intrabdominal structure and protrudes into the retroperitoneal region.