A RARE FORM OF PRESENTATION OF A SMALL INTESTINE GIST IN THE EMERGENCY DEPARTMENT
Gastro-intestinal stromal tumors are a form of mesenchymal tumors most commonly located in the gastro-intestinal tract, as the name suggests. The symptoms that might occur can be abdominal pain or discomfort, early satiety, bloating, jaundice, fatigue, hematemesis or melena. Most of GISTs (>95%) are positive for the KIT protein. Surgery remains the only curative treatment for GIST amenable for resection. High risk tumors can receive adjuvant or neoadjuvant treatment with Imatinib Mesylate, a tyrosin-kinase inhibitor. We present the case of a 59-years old patient that presented with rectal bleeding and abdominal diffuse pain. Blood tests shows leukocytosis and moderate anemia. CT scan describes an expansive, polycyclic process projected at the limit between the mesogastric region and the left flank, in close contact with the small intestine without any clear demarcation line between them and at the superior pole of the tumor, located in an enteral loop, a band of hyperdensity with net contour. Intraoperative, an extraluminal jejunal tumor was found, located at 15 cm from the duodeno-jejunal flexure, with intraluminal active bleeding, which lead us to suspect a GIST based on the macroscopic aspect. We performed segmental enterectomy of 10 cm of the small intestine containing the tumor with entero-enteral anastomosis end to end. The histopathological and immunohistochemistry examinations correlated with the macroscopic aspect have confirmed the diagnosis of GIST.
 E. Fülöp, S. Marcu, D. Milutin, and A. Borda, “Gastrointestinal stromal tumors: review on morphology, diagnosis and management.,” Rom. J. Morphol. Embryol. = Rev. Roum. Morphol. Embryol., vol. 50, no. 3, pp. 319–326, 2009.
 H. Joensuu, “Gastrointestinal stromal tumor (GIST),” Ann. Oncol., vol. 17, no. SUPPL. 10, pp. x280–x286, 2006.
 C. Mucciarini et al., “Incidence and clinicopathologic features of gastrointestinal stromal tumors. A population-based study,” BMC Cancer, vol. 7, no. 1, p. 230, 2007.
 C. L. Corless, J. A. Fletcher, and M. C. Heinrich, “Biology of gastrointestinal stromal tumors,” J. Clin. Oncol., vol. 22, no. 18, pp. 3813–3825, 2004.
 M. Miettinen, L. H. Sobin, and J. Lasota, “Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up.,” Am. J. Surg. Pathol., vol. 29, no. 1, pp. 52–68, Jan. 2005.
 T. Tran, J. A. Davila, and H. B. El-Serag, “The epidemiology of malignant gastrointestinal stromal tumors: an analysis of 1,458 cases from 1992 to 2000.,” Am. J. Gastroenterol., vol. 100, no. 1, pp. 162–168, Jan. 2005.
 M. Ajduk et al., “Spontaneously ruptured gastrointestinal stromal tumor (GIST) of the jejunum mimicking acute appendicitis.,” Coll. Antropol., vol. 28, no. 2, pp. 937–941, Dec. 2004.
 S. Lahoti and N. Fukami, “The small bowel as a source of gastrointestinal blood loss.,” Curr. Gastroenterol. Rep., vol. 1, no. 5, pp. 424–430, Oct. 1999.
 T. Acherjee et al., Gastrointestinal Stromal Tumor (GIST): A Rare Cause of Hematemesis and Hematochezia in an Otherwise Healthy 39-Year-Old Female. no. Md, pp. 3465–3466, 2020.
 Z. Wang, X. Liang, Y. Wang, G. Ma, Y. Qu, and X. Tian, “[Epidemiology survey of gastrointestinal stromal tumor in Shanxi Province in 2011],” Zhonghua Yi Xue Za Zhi, vol. 93, no. 32, pp. 2541–2544, 2013, [Online]. Available: http://europepmc.org/abstract/MED/24351592.
 M. Lv, C. Wu, Y. Zheng, and N. Zhao, “Incidence and Survival Analysis of Gastrointestinal Stromal Tumors in Shanghai: A Population-Based Study from 2001 to 2010,” Gastroenterol. Res. Pract., vol. 2014, p. 834136, 2014.
 K. Søreide, O. M. Sandvik, J. A. Søreide, V. Giljaca, A. Jureckova, and V. R. Bulusu, “Global epidemiology of gastrointestinal stromal tumours (GIST): A systematic review of population-based cohort studies,” Cancer Epidemiol., vol. 40, pp. 39–46, 2016.
 S. Khuri, H. Gilshtein, A. Darawshy, H. Bahouth, and Y. Kluger, “Case Report Primary Small Bowel GIST Presenting as a Life-Threatening Emergency: A Report of Two Cases,” vol. 2017, pp. 5–9, 2017.
 J. R. A. Skipworth, A. E. E. Fanshawe, and M. J. West, “Perforation as a rare presentation of gastric gastrointestinal stromal tumours : a case report and review of the literature,” pp. 1–5, 2014.
 H. H. Wong et al., “Mimics of gastrointestinal stromal tumors (GISTs): Implications for diagnosis and management—The Cambridge GIST Study Group (CGSG) experience.,” J. Clin. Oncol., vol. 31, no. 15_suppl, pp. e21503–e21503, May 2013.
 Y. Chen, Y. Han, and J. Du, “Diagnostic challenges in differentiating intramural gastric abscess from gastric cancer: Two case reports,” Med. (United States), vol. 97, no. 43, pp. 2–5, 2018.
 A. Werewka-Maczuga, T. Osiński, R. Chrzan, M. Buczek, and A. Urbanik, “Characteristics of computed tomography imaging of gastrointestinal stromal tumor (GIST) and related diagnostic problems,” Polish J. Radiol., vol. 76, no. 3, pp. 38–48, 2011.
 J. Blay et al., “Consensus meeting for the management of gastrointestinal stromal tumors Report of the GIST Consensus Conference of 20 – 21 March 2004 , under the auspices of ESMO,” Ann. Oncol., vol. 16, no. 4, pp. 566–578, 2005.
 M. Novelli et al., “DOG1 and CD117 are the antibodies of choice in the diagnosis of gastrointestinal stromal tumours,” Histopathology, vol. 57, no. 2, pp. 259–270, 2010.
 P. Bucher et al., “An audit of surgical management of gastrointestinal stromal tumours (GIST),” Eur. J. Surg. Oncol., vol. 32, no. 3, pp. 310–314, 2006.
Copyright (c) 2021 Romanian Journal of Emergency Surgery
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.