A RARE FORM OF PRESENTATION OF A SMALL INTESTINE GIST IN THE EMERGENCY DEPARTMENT

Abstract

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.