A Case of Gastrointestinal Stromal Tumor (GIST) of Jejunum Presenting as Hollow Organ Perforation

Abstract

Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. A detailed imaging study can help a multidisciplinary team to decide on an appropriate treatment strategy, but variability in clinical presentation often obscures a pre-operative diagnosis of GIST before laparotomy. We describe a case of perforated jejunal GIST with diffuse peritonitis. Case Report: A 69-year-old man with hollow organ perforation and diffuse peritonitis received emergency laparotomy. During the procedure, a large perforated jejunal tumor 15 cm distal to Treitz's ligament and three peritoneal-seeding tumors each less than 1 cm in size were identified. Segmental resection of the diseased jejunum with safe margin, end-to-end anastomosis, and total excision of gross peritoneal-seeding tumors were performed. The patient recovered uneventfully after surgery. Pathology revealed a 7.5×7×6 cm GIST with prominent hemorrhagic infarct arising from the external muscular layer of jejunum. The tumor was classified as high risk by its large size and high mitotic count. The peritoneal tumors were confirmed as seeding of GIST. Discussion: Tumor perforation is a rare presentation of patients with GISTs, accounting for 0-8% of symptomatic cases. In these patients, it is important to confirm that the disease has been completely resected, assess for metastases, and determine stage at laparotomy. A pre-operative computed tomography (CT) is indicated in selected patients with acute abdomen when malignancy is suspected. Complete resection has been proven insufficient for patients with metastatic GISTs. In this case, life-long Imatinib therapy after surgery with regular CT follow-up is necessary.