Abera Samuel Addisu, Tadesse Amanuel Kassa, Abera Kirubel Addisu, Zegeye Kassa Berie, Ibrahim Mohammed Alemu, Feleke Ashenafi Amsalu, Gebrehiwet Cheru Lilay, Mengistu Segenet Bizuneh, Alemu Hirut Tesfahun, Molla Yohannis Derbew
Department of Anatomic Pathology, College of Medicine and Health Sciences University of Gondar Gondar Ethiopia.
Department of Surgery, College of Medicine and Health Sciences University of Gondar Gondar Ethiopia.
Clin Case Rep. 2024 Apr 17;12(4):e8796. doi: 10.1002/ccr3.8796. eCollection 2024 Apr.
Duodenal GISTs are rare and challenging tumors. Acute life-threatening upper GI bleeding is a possible presentation of duodenal GISTs. Surgery is the standard treatment for localized duodenal GISTs. Imatinib is an effective adjuvant therapy for duodenal GISTs.
GIST is the most common mesenchymal neoplasm of the gastrointestinal tract, accounting for 1%-2% of gastrointestinal tumors. They originate from the interstitial cells of Cajal and are rare in patients younger than 30 years. The stomach is the most common site, followed by the small intestine and colon. GISTs are caused by a gain-of-function mutation in the proto-oncogene receptor tyrosine kinase, with activating mutations in KIT being the most common. Most GISTs are asymptomatic. Even if gastrointestinal bleeding is the most common complication life-threatening hemorrhage is extremely uncommon. We present a case of a 31-year-old male patient presented with massive active hematemesis and melena with hemorrhagic shock. The patient presented with massive hematemesis and melena of 1 h duration. Endoscopy showed pulsating active bleeding from the third part of the duodenum which was difficult to manage via endoscopy. Histopathologic evaluation showed spindle cell type GIST. Intraoperatively, there was a nodular mass with active bleeding on the third part of the duodenum. Duodenectomy with end-to-end anastomosis was done. Discharged with no postoperative complication and was put on imatinib. There are considerable challenges that arise in the diagnosis and treatment of duodenal gastrointestinal stromal tumors (GISTs) when they present with life-threatening upper gastrointestinal hemorrhage. In order to achieve the best possible outcomes for patients, it is crucial to have a comprehensive understanding of the clinical presentation, diagnostic methods, and treatment approaches.
十二指肠胃肠道间质瘤（GIST）是罕见且具有挑战性的肿瘤。急性危及生命的上消化道出血是十二指肠GIST的一种可能表现。手术是局限性十二指肠GIST的标准治疗方法。伊马替尼是十二指肠GIST的有效辅助治疗药物。
GIST是胃肠道最常见的间叶性肿瘤，占胃肠道肿瘤的1%-2%。它们起源于 Cajal间质细胞，在30岁以下患者中罕见。胃是最常见的部位，其次是小肠和结肠。GIST由原癌基因受体酪氨酸激酶的功能获得性突变引起，其中KIT激活突变最为常见。大多数GIST无症状。即使胃肠道出血是最常见的并发症，但危及生命的出血极为罕见。我们报告一例31岁男性患者，出现大量活动性呕血和黑便并伴有失血性休克。患者出现持续1小时的大量呕血和黑便。内镜检查显示十二指肠第三部有搏动性活动性出血，难以通过内镜处理。组织病理学评估显示为梭形细胞型GIST。术中，十二指肠第三部有一个结节状肿块伴有活动性出血。行十二指肠切除术并端端吻合。患者术后无并发症出院，并开始服用伊马替尼。当十二指肠胃肠道间质瘤（GIST）出现危及生命的上消化道出血时，其诊断和治疗会面临相当大的挑战。为了使患者获得最佳治疗效果，全面了解临床表现、诊断方法和治疗方法至关重要。
