Gökçe Aylin Hande
Department of General Surgery, İstanbul Medicine Hospital, İstanbul-Turkey.
Ulus Travma Acil Cerrahi Derg. 2019 Jan;25(1):83-85. doi: 10.5505/tjtes.2018.35005.
Gastrointestinal stromal tumors (GISTs) are among the rare tumors of gastrointestinal (GI) tract. GISTs occur respectively in the stomach, small intestines, colon and rectum, omentum and mesentery, esophagus, retroperitoneal space, and abdominal cavity. However, they may occur anywhere along the GI tract. Typically, these tumors generally do not cause symptoms; however symptomatic patients may show stomach pain, GI bleeding, and palpable abdominal masses. These patients usually undergo surgery for obstruction symptoms or some other diagnosis. Our patient was admitted to the emergency department with acute abdomen and hypovolemic shock due to fall. The patient underwent emergency surgery, which revealed active bleeding from a stomach tumor showing an exophytic pattern of growth. This patient was a 32-year-old male, and blood tests revealed a white blood cell count of 23.500/mm³ and a hemoglobin level of 7.9 gr/dL. The heart rate was 110 beats/minute. The chest radiograph showed no subdiaphragmatic free air, and abdominal ultrasound showed impression of a mass that could not be distinguished from the liver, along with closed perforation or hemangioma. During the surgical procedure, 1200 cc of blood was suctioned, and the exophytic tumor was removed completely. Histological analysis of the tumor showed GIST, and it was considered to be a ruptured tumor by the oncology consultant. The patient was applied imatinib for 3 years after the surgery, and the disease did not re-occur during this period. Our goal in this case study is to emphasize that trauma may not be necessarily the cause of acute abdomen for emergency patients but that it also may be caused by hypotension-associated hypovolemic shock or other causes, bleeding from a GIST along with tumor torsion.
胃肠道间质瘤（GISTs）是胃肠道（GI）道的罕见肿瘤之一。GISTs分别发生于胃、小肠、结肠和直肠、网膜和肠系膜、食管、腹膜后间隙及腹腔。然而，它们可能发生于胃肠道的任何部位。通常，这些肿瘤一般不会引起症状；但有症状的患者可能会出现胃痛、胃肠道出血及可触及的腹部肿块。这些患者通常因梗阻症状或其他诊断而接受手术。我们的患者因跌倒导致急腹症和低血容量性休克而被收入急诊科。患者接受了急诊手术，术中发现胃肿瘤有活动性出血，呈外生性生长模式。该患者为32岁男性，血液检查显示白细胞计数为23500/mm³，血红蛋白水平为7.9g/dL。心率为110次/分钟。胸部X线片显示膈下无游离气体，腹部超声显示有一肿块，无法与肝脏区分，同时伴有闭合性穿孔或血管瘤。手术过程中，吸出1200cc血液，并将外生性肿瘤完全切除。肿瘤的组织学分析显示为GIST，肿瘤学顾问认为这是一个破裂的肿瘤。患者术后接受了3年的伊马替尼治疗，在此期间疾病未复发。我们在本病例研究中的目的是强调，创伤不一定是急诊患者急腹症的原因，也可能是由低血压相关的低血容量性休克或其他原因引起，如GIST出血伴肿瘤扭转。
