Easier way of managing gastric gastrointestinal stromal tumor located at unusual site: a case report

Abstract

Intraluminal gastric gastrointestinal stromal tumors (GISTs) located at the posterior wall and near the gastroesophageal (GE) junction represent a surgical challenge. We present a easier laparoscopic assisted mini laparotomy approach for resection of gastric GISTs of such location. A 42 years old female presented with history of Malena and anemia. Endoscopic and contrast enhaced computerised tomography (CECT) scan findings were suggestive of GIST arising from posterior wall along lesser curvature in proximal body of stomach. We planned her for surgical resection of tumor. During laparoscopy, posterior wall stomach was completely mobilised after dividing gastrocolic and phrenogastric ligaments. Due to unfavourable location of tumor in posterior wall and proximity to GE junction, accessibility for negative resection margin was difficult, so we did mini laparotomy (approx 5 cm midline incision) and already mobilised stomach is delivered out, wedge resection of tumor done after assuring resection margin with direct palpation. GISTs of the posterior wall and in close proximity to the GE junction can be safely resected with laparoscopic assistance using such an approach. This technique is useful alternative in unavailability of simultaneous laparoscopy with endoscopy as required in laparoscopic and endoscopic cooperative surgery in such locations of tumor.