GIST in Third Part of Duodenum Causing Partial Obstruction – Laparoscopic Management

Abstract

Background: Gastrointestinal Stromal Tumor (GIST) arises from the interstitial cells of Cajal. Stomach is the most common site of GIST. The usual presentations of GIST are gastrointestinal bleeding and abdominal pain. GISTs in the duodenum are uncommon. Duodenal obstruction due to GIST is even more uncommon. Duodenal GISTs are usually detected on endoscopy, however they can be missed on routine endoscopy if they are located in the third part of duodenum. Computed Tomography (CT) of abdomen is useful in determining the exact size, location and extent of tumor. In the absence of metastases, surgical excision is the mainstay of treatment. Case Presentation: We present a case of a duodenal GIST in the 3rd part of duodenum, causing partial obstruction to the duodenal lumen and causing recurrent abdominal pain and vomiting. Although technically challenging, we successfully excised this lesion laparoscopically. Furthermore, as it was a pedunculated tumor arising from the posterior wall of the duodenum, we performed a novel technique of laparoscopic duodenotomy and stapling of pedunculated tumor at the base and primary closure, rather than the conventional technique of wedge or segmental resection. Conclusion: Third part of the duodenum is a difficult location to access surgically and excision of tumors in this location is usually performed by the open method because of the technical difficulties of laparoscopic surgery in this location. However, with adequate expertise and advanced laparoscopic skills, laparoscopic excision of tumors in the third part of duodenum can be accomplished with good post-operative outcomes.