Shaw Alexander, Jeffery John, Dias Laura, Nazir Sarfraz
Department of Plastic Surgery, Wexham Park Hospitals, Slough SL2 4HL, UK.
Case Rep Gastrointest Med. 2013;2013:562642. doi: 10.1155/2013/562642. Epub 2013 Mar 27.
Background. Duodenal gastrointestinal stromal tumours (GISTs) are an uncommon malignancy of the gastrointestinal (GI) tract. We present a case of life-threatening haemorrhage caused by a large ulcerating duodenal GIST arising from the third part of the duodenum managed by a limited duodenal wedge resection. Case Presentation. A 61-year-old patient presented with acute life-threatening gastrointestinal bleeding. After oesophagogastroduodenoscopy failed to demonstrate the source of bleeding, a 5 cm ulcerating exophytic mass originating from the third part of the duodenum was identified at laparotomy. A successful limited wedge resection of the tumour mass was performed. Histopathology subsequently confirmed a duodenal GIST. The patient remained well at 12-month followup with no evidence of local recurrence or metastatic spread. Conclusion. Duodenal GISTs can present with life-threatening upper GI haemorrhage. In the context of acute haemorrhage, even relatively large duodenal GISTs can be treated by limited wedge resection. This is a preferable alternative to duodenopancreatectomy with lower morbidity and mortality but comparable oncological outcome.
背景。十二指肠胃肠道间质瘤（GISTs）是胃肠道（GI）的一种罕见恶性肿瘤。我们报告一例由起源于十二指肠第三部的巨大溃疡性十二指肠GIST引起的危及生命的出血病例，该病例通过有限的十二指肠楔形切除术进行治疗。病例介绍。一名61岁患者出现急性危及生命的胃肠道出血。在食管胃十二指肠镜检查未能显示出血源后，剖腹手术时发现一个起源于十二指肠第三部的5厘米溃疡性外生性肿块。成功地对肿瘤肿块进行了有限的楔形切除。组织病理学随后证实为十二指肠GIST。患者在12个月的随访中情况良好，没有局部复发或转移扩散的迹象。结论。十二指肠GIST可表现为危及生命的上消化道出血。在急性出血的情况下，即使是相对较大的十二指肠GIST也可通过有限的楔形切除术进行治疗。这是一种比胰十二指肠切除术更可取的替代方法，其发病率和死亡率较低，但肿瘤学结果相当。
