Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University School of Medicine, 1 Hoegi-Dong, Dongdaemun-Gu, Seoul, 130-702, Republic of Korea.
Surg Today. 2011 Aug;41(8):1085-90. doi: 10.1007/s00595-010-4434-6. Epub 2011 Jul 20.
Colonic gastrointestinal stromal tumors (GISTs) account for only 5%-10% of tumors arising in the digestive tract. Spontaneous rupture is a very rare manifestation of a GIST; however, we report what to our knowledge is the first documented case of pneumoretroperitoneum caused by the rupture of a GIST. A 77-year-old woman was admitted to our hospital with acute abdominal pain and hematochezia. Colonoscopy showed luminal narrowing in the sigmoid colon, but no definite mucosal defect. Computed tomography (CT) showed an air-containing heterogeneous mass, 9.7 × 9.3 cm, in the pelvic cavity and a small amount of air in the retroperitoneum. Emergency laparotomy revealed a ruptured sigmoid colonic GIST with localized peritonitis. Pathologic examination confirmed that the tumor was composed mainly of round epithelioid cells. It was immunohistochemically positive for CD34 and negative for C-kit protein. This report describes how we successfully managed pneumoretroperitoneum with localized peritonitis caused by the spontaneous rupture of an epithelioid GIST originating from the sigmoid colon.
结肠胃肠道间质瘤（GISTs）仅占消化道肿瘤的 5%-10%。GIST 自发破裂是一种非常罕见的表现；然而，我们报告了据我们所知首例由 GIST 破裂引起的气腹症。一名 77 岁女性因急性腹痛和血便入院。结肠镜检查显示乙状结肠腔内狭窄，但无明确的黏膜缺损。计算机断层扫描（CT）显示盆腔内有一个 9.7×9.3cm 的含气混杂肿块，后腹膜腔有少量气。急诊剖腹探查显示乙状结肠 GIST 破裂伴局限性腹膜炎。病理检查证实肿瘤主要由圆形上皮样细胞组成。免疫组织化学染色 CD34 阳性，C-kit 蛋白阴性。本报告描述了我们如何成功地治疗由起源于乙状结肠的上皮样 GIST 自发破裂引起的局限性腹膜炎伴气腹症。
