Taskovska Milena, Omejc Mirko, Grosek Jan
Department of Urology, University Medical Centre Ljubljana, Zaloška c. 7, 1000 Ljubljana, Slovenia.
Department of Abdominal surgery, University Medical Centre Ljubljana, Zaloška c. 7, 1000 Ljubljana, Slovenia.
Int J Surg Case Rep. 2019;57:160-162. doi: 10.1016/j.ijscr.2019.03.035. Epub 2019 Mar 30.
Duodenal gastrointestinal stromal tumors (DGISTs) are mesenchymal tumors. Main presenting symptoms are gastrointestinal bleeding and non-specific abdominal pain. Surgical treatment is golden standard for treatment of DGISTs. Tumour location and size determine the surgical strategy. Recurrence rate depends on tumour location and completeness on removal.
75 years old male fell ill with hematemesis, hemohesia and dizziness. Oesophagogastroduodenoscopy (EGD) did not reveal the source of bleeding. Upon admission, a second EGD was performed due to loss of consciousness and anaemia, which revealed only approximate source of bleeding in the third portion of the duodenum. The exact bleeding spot could not be reached and bleeding could not be controlled endoscopically. Patient was transferred to the operating room for an emergency explorative laparotomy. After extensive mobilisation of the duodenum a 2 × 2 cm intraluminal tumour with central bleeding ulceration was found in D3. The diseased part of the duodenum was excised and the duodenotomy was closed with interrupted sutures. Final pathohistological report confirmed gastrointestinal stromal tumour, pT1. Postoperative period was uneventful.
Gastrointestinal stromal tumours are most common in males aged 60-65 years. Surgical treatment is a golden standard. Surgical approach depends upon tumor location and size. In case of major bleeding surgical procedure is lifesaving and diagnostics for staging purposes are omitted.
Gastrointestinal stromal tumors are a potential source of life-threatening bleeding. In such cases an emergency operation is often indicated with aim to remove the tumour en bloc and achieve hemostasis as soon as possible.
十二指肠胃肠道间质瘤（DGISTs）是间叶组织肿瘤。主要临床表现为胃肠道出血和非特异性腹痛。手术治疗是DGISTs的金标准。肿瘤的位置和大小决定手术策略。复发率取决于肿瘤位置和切除的完整性。
一名75岁男性因呕血、便血和头晕入院。食管胃十二指肠镜检查（EGD）未发现出血源。入院时，因意识丧失和贫血进行了第二次EGD检查，仅发现十二指肠第三段大致出血源。无法到达确切的出血点，内镜下无法控制出血。患者被转至手术室进行急诊剖腹探查术。广泛游离十二指肠后，在D3段发现一个2×2cm腔内肿瘤，中央有出血性溃疡。切除十二指肠病变部分，用间断缝合关闭十二指肠切口。最终病理组织学报告证实为胃肠道间质瘤，pT1。术后恢复顺利。
胃肠道间质瘤最常见于60 - 65岁男性。手术治疗是金标准。手术方式取决于肿瘤的位置和大小。在大出血的情况下，手术是挽救生命的，省略分期诊断。
胃肠道间质瘤是危及生命的出血潜在来源。在这种情况下，通常需要进行急诊手术，目的是整块切除肿瘤并尽快止血。
