Dev Santosh, Luitel Prajjwol, Paudel Sujan, Shrestha Asim, Dev Barsha, Sah Jayant
Department of General Surgery, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Nepal.
Department of General Surgery, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Nepal; Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Nepal.
Int J Surg Case Rep. 2024 Aug;121:109922. doi: 10.1016/j.ijscr.2024.109922. Epub 2024 Jun 21.
Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors, with jejunal GISTs being particularly uncommon. Jejunal GISTs causing perforation and acute diffuse peritonitis is rare.
A 53-year-old female with a history of hypertension presented with severe, acute abdominal pain and vomiting. Examination revealed abdominal distension, tenderness, and guarding, with imaging suggestive of gastrointestinal perforation. Emergency laparotomy revealed a 9 cm × 8 cm mass with perforation in the jejunum, which was resected which on histopathological examination confirmed a low-grade GIST. The postoperative course was complicated by a wound infection, managed with antibiotics and secondary suturing. At one-year follow-up, the patient remained disease-free without the need for adjuvant therapy.
The most common symptoms of jejunal GISTs include vague abdominal pain or discomfort, early satiety, obstruction or hemorrhage. Preoperative diagnosis and confirmation of GIST is difficult due to nonspecific symptoms and none of the radiographic procedures can establish the diagnosis with certainty. The surgical excision of the tumor along with infiltrated tissues is the treatment of choice for GIST.
This case underscores the necessity of considering GISTs in differential diagnoses of acute abdomen and the critical role of prompt surgical management and multidisciplinary care in achieving favorable outcomes.
胃肠道间质瘤(GISTs)是罕见的间叶组织肿瘤,空肠GISTs尤其少见。导致穿孔和急性弥漫性腹膜炎的空肠GISTs很罕见。
一名有高血压病史的53岁女性,出现严重的急性腹痛和呕吐。检查发现腹胀、压痛和肌紧张,影像学检查提示胃肠道穿孔。急诊剖腹探查发现空肠有一个9厘米×8厘米的肿块并伴有穿孔,予以切除,组织病理学检查证实为低级别GIST。术后病程因伤口感染而复杂化,通过抗生素治疗和二次缝合处理。在一年的随访中,患者无疾病复发,无需辅助治疗。
空肠GISTs最常见的症状包括腹部隐痛或不适、早饱、梗阻或出血。由于症状不具特异性,术前诊断和确诊GIST很困难,且没有任何影像学检查能确定诊断。手术切除肿瘤及受累组织是GIST的首选治疗方法。
该病例强调了在急腹症鉴别诊断中考虑GISTs的必要性,以及及时手术治疗和多学科护理在取得良好预后方面的关键作用。