Duodenal Wedge Resection for Large Gastrointestinal Stromal Tumour Presenting with Life-Threatening Haemorrhage

Background. Duodenal gastrointestinal stromal tumours (GISTs) are an uncommon malignancy of the gastrointestinal (GI) tract. We present a case of life-threatening haemorrhage caused by a large ulcerating duodenal GIST arising from the third part of the duodenum managed by a limited duodenal wedge resection. Case Presentation. A 61-year-old patient presented with acute life-threatening gastrointestinal bleeding. After oesophagogastroduodenoscopy failed to demonstrate the source of bleeding, a 5？cm ulcerating exophytic mass originating from the third part of the duodenum was identified at laparotomy. A successful limited wedge resection of the tumour mass was performed. Histopathology subsequently confirmed a duodenal GIST. The patient remained well at 12-month followup with no evidence of local recurrence or metastatic spread. Conclusion. Duodenal GISTs can present with life-threatening upper GI haemorrhage. In the context of acute haemorrhage, even relatively large duodenal GISTs can be treated by limited wedge resection. This is a preferable alternative to duodenopancreatectomy with lower morbidity and mortality but comparable oncological outcome. 1. Background Gastrointestinal stromal tumours (GISTs) are generally considered to be an uncommon soft tissue malignancy of the gastrointestinal tract. They predominantly occur in patients over the age of 50. They constitute 0.1% to 3% of all gastrointestinal tumours with an incidence equivalent to 10–20 cases per million [1, 2]. These tumours occur anywhere along the length of the gastrointestinal tract with the majority, 60%–70%, arising in the stomach. A further 20%–30% occur in the small bowel. On the whole GISTs of the duodenum are only found in 3%–5% of cases and it remains a rare location for their development [3]. When they do occur, the majority localise to the second portion of the duodenum (42/156 in one study) and as a result are frequently located close to the ampulla of Vater [3, 4]. Of all those that are surgically resected, 6%–21% are located in the duodenum [5, 6]. GISTs tend to present with vague nonspecific abdominal symptoms such as pain, a mass, or an occult gastrointestinal bleed. Occasionally patients will present with more severe symptoms such as obstruction, perforation, or severe acute bleeding as in the case described below [7]. The identification of the source of bleeding may be determined by upper gastrointestinal endoscopy when the tumour is located in the stomach or proximal duodenum. Those found incidentally tend to be small, with a mean diameter of 1.5？cm and carry a better