Sankey Ruth E, Maatouk Mohamed, Mahmood Arshad, Raja Mazhar
General Surgery Department, Milton Keynes General Hospital, Milton Keynes, UK
General Surgery Department, Milton Keynes General Hospital, Milton Keynes, UK.
J Surg Case Rep. 2015 May 1;2015(5):rjv050. doi: 10.1093/jscr/rjv050.
Gastrointestinal stromal tumours (GISTs) are rare. GISTs comprise 0.2% of gastrointestinal tumours and only 0.04% of small intestinal tumours. Jejunal GISTs are the rarest subtype. Only 10-30% progress to malignancy [Choi (Response evaluation of gastrointestinal stromal tumors. Oncologist 2008; 13: :4-7)]. We present a 70-year-old male, with multiple co-morbidities, who had extensive investigations over 5 years for vague abdominal pain. All investigations were normal. He presented with symptoms and signs of small bowel obstruction (SBO), confirmed on a computed tomography scan and demonstrated to be secondary to lesion-induced intussusception. The patient had emergency small bowel resection, was discharged after 4 days and remains well. This case report highlights the rarity of jejunal GISTs and, as extensive initial investigation yielded all false-negative results, indicates the difficulty in diagnosing jejunal GISTs. Adhesions are the commonest cause of SBO in patients with previous abdominal surgery, followed by newly diagnosed malignancies [Beardsley et al. (Small bowel obstruction in the virgin abdomen: the need for a mandatory laparotomy explored. Am J Surg 2014; 208: :243-8)]. Consequently, in patients with a virgin abdomen, underlying tumours should be considered.
胃肠道间质瘤（GISTs）较为罕见。GISTs占胃肠道肿瘤的0.2%，仅占小肠肿瘤的0.04%。空肠GISTs是最罕见的亚型。只有10% - 30%会进展为恶性肿瘤[Choi（胃肠道间质瘤的疗效评估。肿瘤学家2008年；13: 4 - 7）]。我们报告一例70岁男性，患有多种合并症，因不明原因的腹痛在5年期间接受了广泛检查。所有检查结果均正常。他出现小肠梗阻（SBO）的症状和体征，经计算机断层扫描证实，显示为病变引起的肠套叠所致。患者接受了急诊小肠切除术，4天后出院，目前情况良好。本病例报告强调了空肠GISTs的罕见性，并且由于最初的广泛检查均得出假阴性结果，表明空肠GISTs的诊断存在困难。粘连是既往有腹部手术史患者发生SBO的最常见原因，其次是新诊断的恶性肿瘤[Beardsley等人（未做过腹部手术患者的小肠梗阻：探讨强制剖腹手术的必要性。美国外科杂志2014年；208: 243 - 8）]。因此，对于未做过腹部手术的患者，应考虑潜在肿瘤的可能性。
