Arata Ryosuke, Nakahara Hideki, Urushihara Takashi, Itamoto Toshiyuki, Nishisaka Takashi
Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan.
Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan.
Int J Surg Case Rep. 2020;69:68-71. doi: 10.1016/j.ijscr.2020.03.017. Epub 2020 Apr 1.
Early diagnosis of small intestinal gastrointestinal stromal tumours (GISTs) is difficult. These tumours often present with peritonitis and intraperitoneal bleeding due to rupture. We experienced a case of a tumor that grows to 12 cm asymptomatic.
A 46-year-old man presented with sudden abdominal pain. Computed tomography revealed free air in the abdominal cavity, a 12-cm sized dilatation in the small intestine, and pooled residues. He was diagnosed with perforation of the gastrointestinal tract, and emergency surgery was performed. Inside the abdominal cavity, approximately 500 mL of bloody ascites was observed. A diverticulum-like mass measuring approximately 12-cm long was observed on the jejunum approximately 30 cm from the Treitz ligament. There was a large hematoma inside the mass, and perforation was recognised at the neck of the diverticulum. Partial resection of the jejunum and intraperitoneal drainage were performed. Immunohistochemistry revealed that the tumour was positive for KIT and CD34, and GIST was diagnosed. The patient was discharged on postoperative day 10 without significant complications. The patient did not relapse while taking imatinib as an adjuvant chemotherapy.
Gastrointestinal stromal tumours are the most common mesenchymal tumours of the gastrointestinal tract and may undergo increased diverticulum-like growth, as seen in this case. Local resection and proper chemotherapy increase long-term survival, suppress tumour growth, and reduce the risk of relapse.
Diagnosing GIST can be difficult due to the absence of clinical symptoms. It is necessary to ensure local resection and careful long-term follow-up.
小肠胃肠道间质瘤（GISTs）的早期诊断较为困难。这些肿瘤常因破裂而表现为腹膜炎和腹腔内出血。我们遇到一例肿瘤长到12厘米却无症状的病例。
一名46岁男性突发腹痛。计算机断层扫描显示腹腔内有游离气体、小肠有12厘米大小的扩张以及积液残留。他被诊断为胃肠道穿孔，并接受了急诊手术。腹腔内可见约500毫升血性腹水。在距屈氏韧带约30厘米的空肠处观察到一个约12厘米长的憩室样肿物。肿物内有一个大血肿，憩室颈部可见穿孔。进行了空肠部分切除术和腹腔引流。免疫组织化学显示肿瘤KIT和CD34呈阳性，诊断为GIST。患者术后第10天出院，无明显并发症。患者在接受伊马替尼辅助化疗期间未复发。
胃肠道间质瘤是胃肠道最常见的间叶组织肿瘤，可能会出现如本例所见的憩室样生长增加。局部切除和适当的化疗可提高长期生存率、抑制肿瘤生长并降低复发风险。
由于缺乏临床症状，GIST的诊断可能较为困难。确保局部切除并进行仔细的长期随访很有必要。
