Massive gastrointestinal bleeding caused by a gastrointestinal stromal tumour of the third part of the duodenum treated by means of emergency partial duodenal resection

The gastrointestinal stromal tumour (GIST) is a carcinoma derived from precursor stem cells, which differentiate into pacemaker intramural neural cells (Cajal’s cells). Once classified as leiomyoma, leiomyoblastoma, leiomyosarcoma, or Schwannoma, it becomes a separate disease entity and the most common sarcoma of the gastrointestinal tract. The above-mentioned tumours are mainly found in the stomach (40–70%) and small bowel (20–50%), less frequently in the colon and oesophagus (< 5%), and rarely outside the gastrointestinal tract (omentum, mesentery, retroperitoneal space).
The incidence rate is estimated at 3–16 cases/1 mln inhabitants, yearly. The presumed number of new cases in Poland is approximately 600 per year [1]. The carcinoma is usually diagnosed in patients after the age of 50 years, more often in the male population. Tumours small in size are asymptomatic. Those located submucosally may be the cause of chronic or subacute, rarely, massive gastrointestinal bleeding [2–5].
The most effective method of treating GIST is radical surgery. Due to the complex duodeno-pancreatic anatomy, a variety of surgical techniques have been proposed in the management of duodenal stromal tumours, from wedge resections to radical pancreatoduodenectomy, depending on the location and size of the tumour [5–12].
The Authors presented a case of radical surgery, considering a massively bleeding duodenal stromal tumour during an emergency shift, which consisted of segmental duodenectomy.
A 45-year-old male patient was directed to the Department of Surgery during an emergency shift, due to massive gastrointestinal bleeding. Bleeding symptoms, including melena and haematemesis, appeared several hours before the hospitalisation. The patient was pale and weak, without a history of coexisting diseases, blood pressure (BP) 100/60 mm Hg, heart rate (HR) 140/min. Prior to gastroscopy, conservative treatment was initiated and blood samples were collected. Since the patient was conscious and cooperative, endoscopy was performed under local anaesthesia assisted by an anaesthesiologist. A large amount of blood was found in the stomach and duodenum, and after its partial aspiration, in the third part of the duodenum we revealed the presence of a large submucosal tumour with a centrally located bleeding ulceration, Forrest Ib. An adrenalin solution 1 : 10000 was injected into the ulceration, and the bleeding was stopped (Figure 1). Conservative treatment was...


Pełna treść artykułu...