Unexpected Gastrointestinal Stromal Tumor as Acute Abdomen in First Trimester of Pregnancy

Abstract

A gastrointestinal stromal tumour (GIST) is a tumor of the gastrointestinal tract. We present a 36-year-old, gravida 2 para 1 lady presented with acute lower abdominal pain at 9 weeks period of amenorrhea (POA) associated with vomiting. She had a previous uncomplicated cesarean section 2 years ago. Abdominal examination revealed a tender and mobile 26-week-sized mass. A transabdominal scan revealed a right adnexal mass with a cystic component measuring 10 cm x 10 cm in size, as well as a viable singleton intrauterine fetus corresponding to her dates. She underwent emergency laparotomy in suspicion of a right twisted ovarian cyst. The inoperative finding revealed a large pedunculated and twisted gangrenous mass from the greater curvature of the stomach with normal uterus and ovaries. The histopathological examination of the mass reported as malignant Sarcomatoid epithelioid GIST (category 3b). The patient was managed by a multidisciplinary team approach involving the obstetrician & gynaecologist, surgeon and oncologist throughout her pregnancy course. The pregnancy progressed well, and she delivered via elective repeat cesarean section. Post partumly, oesophago-gastric-duodeno-scopy and computed tomography assessment revealed no evidence of local disease or distant metastasis. She was advised for yearly follow-up with the surgical department.