Intraperitoneal bleeding and haemorrhagic shock caused by ruptured stomach GIST

Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract. They arise most commonly in the stomach (60–70%) and small intestine (20–25%), while other sites of origin are rare [1, 2]. In many cases, they are diagnosed accidentally due to their indolent clinical course; however, 10–30% of these have malignant potential [2–4]. Symptoms depend mostly on tumour localization and size. Around 70% of tumours present with abdominal pain, and 20–50% present with gastrointestinal bleeding, which is predominantly intraluminal, and rarely an exophytic type of GIST may rupture and bleed into the peritoneal cavity [3, 4]. GIST of the small bowel can lead to intestinal obstruction, while oesophageal GIST causes dysphagia. Gastric and oesophageal GISTs carry a better prognosis than small bowel GISTs of similar size and mitotic rate [4]. Tyrosine kinase inhibitors (imatinib or sunitinib) are the main chemotherapeutic options in unresectable, metastatic, or recurrent GISTs.  A 41-year-old man with no significant comorbidities presented to the emergency department with syncope and diffuse abdominal pain of 24-hour duration. No abdominal trauma was reported by the patient. The patient reported bloating and intermittent abdominal pain without nausea for the last 2 weeks. On physical examination upon admission, his vital signs showed tachycardia of 112 beats/min and hypotension of 90/60 mm Hg. An abdominal examination revealed periumbilical tenderness and abdominal distension. Laboratory tests revealed low haemoglobin (8.7 g/dl) and no other unusual findings. Computed tomography (CT) scan was performed to rule out intraabdominal haemorrhage, and it revealed a large expansive mass in the upper abdomen attached to the greater curvature of the stomach and left liver lobe and extending inferiorly to the level of the umbilicus. It had axial dimensions of 21  8.3 cm and contained hyperdense areas that suggested active bleeding. There was dense free fluid in the perisplenic and perihepatic area. Haemoperitoneum was suspected, and urgent exploratory laparotomy was performed. Intraoperatively, 2000 ml of intraperitoneal blood was found originating from a large exophytic necrotic tumour that arose from the front wall of the stomach body. The haematoma was evacuated, and a partial wedge stomach resection with the tumour using the stapling device was performed. Macroscopically, no other tumours or metastases were detected. The...


Pełna treść artykułu...