Gastrointestinal stromal tumor (GIST) is the most
common mesenchymal tumor and has a malignant potential. The clinical
presentation with pneumoperitoneum and peritonitis is extremely rare. We report
a case of a 40-year-old male presented with symptoms of acute abdomen. Radiological
work-up confirmed pneumoperitoneum. Emergency laparatomy and complete resection
were performed. The final diagnosis revealed perforated GIST originating from
the jejunum. If an abdominal mass presents with pneumoperitoneum and
peritonitis, jejunal GIST should be considered in diagnosis. A complete radical
resection followed by postoperative adjuvant chemotheraphy with Imatinib is
recommended.
References
[1]
Crosby, A., Catton, C.N., Davis, A., Couture, J., O’Sullivan, B., Kandel, R. and Swallow, C.J. (2001) Malignant Gastrointestinal Tumors of the Small Intestine: A Review of 50 Cases from a Prospective Database. Annals of Surgical Oncology, 8, 50-59. http://dx.doi.org/10.1007/s10434-001-0050-4
[2]
Miettinen, M., El-Rifai, W., HL Sobin, L. and Lasota J. (2002) Evaluation of Malignancy and Prognosis of Gastrointestinal Stromal Tumors: A Review. Human Pathology, 33, 478-483. http://dx.doi.org/10.1053/hupa.2002.124123
[3]
Kumar, A., et al. (2012) The Etiology of Pneumoperitoneum in the 21st Century. Journal of Trauma and Acute Care Surgery, 73, 542-548.
[4]
Sornmayura, P. (2009) Gastrointestinal Stromal Tumors (GISTs): A Pathology View Point. Journal of the Medical Association of Thailand, 92, 124-135.
[5]
Mazur, M.T. and Clark, H.B. (1983) Gastric Stromal Tumors. Reappraisal of Histogenesis. American Journal of Surgical Pathology, 7, 507-519. http://dx.doi.org/10.1097/00000478-198309000-00001
[6]
Roy, S.D., Khan, D., De., K.K. and De., U. (2012) Spontaneous Perforation of Jejunal Gastrointestinal Stromal Tumor. Case Report and Review of Literature. World Journal of Emergency Surgery, 7, 37. http://dx.doi.org/10.1186/1749-7922-7-37
[7]
Skipworth, J.R., Fanshawe, A.E., West, M.J. and Al-Bahrani, A. (2014) Perforation as a Rare Presentation of Gastric Gastrointestinal Stromal Tumors: A Case Report and Review of the Literature. Annals of The Royal College of Surgeons of England, 96, 96E-100E.
[8]
Sjogren, P.P., Banerji, N., Batts, K.P., Graczyk, M.J. and Dunn, D.H. (2013) Rare Presentation of Gastrointestinal Stromal Tumor with Spontaneous Esophageal Perforation: A Case Report. International Journal of Surgery Case Reports, 4, 636-639. http://dx.doi.org/10.1016/j.ijscr.2013.02.029
[9]
Memmi, N., Cipe, G., Bektasoglu, H., Toydemir, T., Kadioglu, H., Bozkurt, S., Buyukpinarbasili, N., Karatepe, O. and Muslumanoglu, M. (2012) Perforated Gastrointestinal Stromal Tumor in the Jejunum: A Rare Cause of Acute Abdomen. Oncology Letters, 4, 1244-1246.
[10]
Efremidou, E.I., Liratzopoulos, N., Papageorgiou, M.S. and Romanidis, K. (2006) Perforated GIST of the Small Intestine as a Rare Cause of Acute Abdomen: Surgical Treatment and Adjuvant Therapy. Case Report. Journal of Gastrointestinal and Liver Diseases, 15, 297-299.
[11]
Catena, F., Ansaloni, L., Gazzotti, F., Gagliardi, S., Di Saverio, S., De Cataldis, A. and Taffurelli, M. (2005) Small Bowel Tumors in Emergency Surgery: Specificity of Clinical Presentation. ANZ Journal of Surgery, 75, 997-999. http://dx.doi.org/10.1111/j.1445-2197.2005.03590.x
[12]
Demir, L., Ekinci, N., Erten, C., Kucukzeybek, Y., Alacacioglu, A., Somali, I., Can, A., Dirican, A., Bayoglu, V., Akyol, M., Cakalagaoglu, F. and Tarhan, M.O. (2013) Does Immunohistochemistry Provide Additional Prognostic Data in Gastrointestinal Stromal Tumors? Asian Pacific Journal of Cancer Prevention, 14, 4751-4758.
[13]
Fong, Y.M., Coit, D.G., Woodruff, J.M. and Brennan, M.F. (1993) Lymph Node Metastasis from Soft Tissue Sarcoma in Adults. Analysis of Data from a Prospective Database of 1772 Sarcoma Patients. Annals of Surgery, 217, 72-77. http://dx.doi.org/10.1097/00000658-199301000-00012