Behi Hager, Omry Ahmed, Guelmami Hanene, Changuel Amel, Kamtaoui Amal, Khalifa Med Bachir
General Surgery Department, Military Hospital of Tunis, Mont Fleury, 1008 Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street, Bab Saadoun, 1007 Tunis, Tunisia.
General Surgery Department, Military Hospital of Tunis, Mont Fleury, 1008 Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street, Bab Saadoun, 1007 Tunis, Tunisia.
Int J Surg Case Rep. 2024 Jun;119:109739. doi: 10.1016/j.ijscr.2024.109739. Epub 2024 May 9.
Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms predominantly affecting the gastrointestinal tract. While they often remain asymptomatic, GISTs can lead to acute abdominal emergencies, such as peritonitis secondary to tumor perforation, a rare yet serious complication. Here, we present a unique case of a locally advanced ileal gastrointestinal stromal tumor complicated by generalized purulent peritonitis, emphasizing the diagnostic and management challenges associated with this condition.
A 68-year-old male presented with worsening abdominal pain, vomiting, fever, and weight loss. Imaging studies revealed a large solid-cystic mass originating from the terminal ileum, prompting emergency surgery. Intraoperative findings included a multilobulated tumor mass invading the mesocolon, necessitating hemicolectomy. Histopathological analysis confirmed a high-risk gastrointestinal stromal tumor, leading to initiation of adjuvant therapy with imatinib mesylate.
GISTs often present with nonspecific symptoms, posing diagnostic challenges. Peritonitis secondary to tumor perforation is a rare yet critical complication requiring prompt surgical intervention. Complete resection remains the mainstay of treatment, with adjuvant imatinib therapy showing promise in high-risk cases.
This case report sheds light on the complexities of diagnosing and managing locally advanced gastrointestinal stromal tumors (GISTs) complicated by peritonitis. Complete tumor resection is crucial for potential cure, with adjuvant therapy using imatinib showing promise, especially in high-risk cases. Thorough diagnostic assessment, timely intervention, and comprehensive follow-up are essential for optimizing outcomes in complex GIST presentations.
胃肠道间质瘤（GISTs）是罕见的间叶组织肿瘤，主要累及胃肠道。虽然它们通常无症状，但GISTs可导致急性腹部急症，如肿瘤穿孔继发的腹膜炎，这是一种罕见但严重的并发症。在此，我们报告一例独特的局部晚期回肠胃肠道间质瘤合并弥漫性化脓性腹膜炎的病例，强调了与此病症相关的诊断和管理挑战。
一名68岁男性出现腹痛加重、呕吐、发热和体重减轻症状。影像学检查显示一个源自回肠末端的巨大实性囊性肿块，遂进行急诊手术。术中发现包括一个多叶状肿瘤肿块侵犯结肠系膜，需要进行半结肠切除术。组织病理学分析证实为高危胃肠道间质瘤，因此开始使用甲磺酸伊马替尼进行辅助治疗。
GISTs通常表现为非特异性症状，给诊断带来挑战。肿瘤穿孔继发的腹膜炎是一种罕见但关键的并发症，需要及时进行手术干预。完整切除仍然是主要的治疗方法，辅助性伊马替尼治疗在高危病例中显示出前景。
本病例报告揭示了诊断和管理合并腹膜炎的局部晚期胃肠道间质瘤（GISTs）的复杂性。完整的肿瘤切除对于潜在治愈至关重要，使用伊马替尼的辅助治疗显示出前景，尤其是在高危病例中。全面的诊断评估、及时的干预和全面的随访对于优化复杂GIST病例的治疗结果至关重要。
