Basnayake Oshan, Jayarajah Umesh, Fernandopulle Nilesh, Sivaganesh Sivasuriya
Professorial Surgical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.
Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka.
Case Rep Surg. 2021 Jan 18;2021:6674612. doi: 10.1155/2021/6674612. eCollection 2021.
Gastrointestinal stromal tumours (GIST) are neoplasms which originate from the mesenchymal tissue of the gastrointestinal tract. We report on a GIST presenting with acute gastrointestinal bleeding that mimicked an arteriovenous malformation (AVM) on imaging and at surgery. A 61-year-old female presented with a short history of melaena and severe anaemia. After resuscitation, upper gastrointestinal endoscopy showed a profusely bleeding varix in the proximal jejunum which was treated with glue injection. Contrast-enhanced CT showed a heterogeneous lesion in the proximal jejunum with strong arterial phase enhancement, supplied by a branch of the superior mesenteric artery and drained by a prominent tributary of the superior mesenteric vein, suggestive of an AVM. The mass was resected, and histology revealed a GIST with no evidence of an AVM or angiodysplasia. A GIST may be considered, though imaging suggests a diagnosis of an AVM in patients presenting with acute gastrointestinal bleeds. In such circumstances, surgical resection and pathological assessment will be confirmatory.
胃肠道间质瘤（GIST）是起源于胃肠道间叶组织的肿瘤。我们报告了一例以急性胃肠道出血为表现的GIST，其在影像学和手术中均酷似动静脉畸形（AVM）。一名61岁女性，有短期黑便和严重贫血病史。复苏后，上消化道内镜检查显示空肠近端有一大量出血的静脉曲张，予以注射胶水治疗。增强CT显示空肠近端有一不均匀病变，动脉期强化明显，由肠系膜上动脉分支供血，经肠系膜上静脉一粗大属支引流，提示为AVM。该肿块被切除，组织学检查显示为GIST，未发现AVM或血管发育异常的证据。对于急性胃肠道出血的患者，尽管影像学提示为AVM，但仍可能考虑为GIST。在这种情况下，手术切除和病理评估将起到确诊作用。
