Doita Susumu, Watanabe Megumi, Ogawa Toshihiro, Tanakaya Kohji, Aoki Hideki
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JPN.
Department of Surgery, National Hospital Organization Iwakuni Clinical Center, Iwakuni, JPN.
Cureus. 2024 Sep 20;16(9):e69799. doi: 10.7759/cureus.69799. eCollection 2024 Sep.
Spontaneous hemoperitoneum is a rare and potentially life-threatening condition with a wide differential diagnosis. Gastrointestinal stromal tumors (GIST) can present with spontaneous hemoperitoneum, although diagnosing GIST as the cause of hemoperitoneum is challenging due to its rarity. A 76-year-old Japanese man presented with sudden epigastric pain and was found to have a 10 cm space-occupying lesion and ascites on ultrasonography. Despite stable vital signs, computed tomography (CT) findings showed a 10×15 cm mass with heterogeneously enhanced solid and cystic lesions, and the patient opted for conservative treatment. Two months later, a contrast-enhanced CT scan revealed a high-density area within the hematoma, prompting further investigation with fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT), which showed FDG accumulation suggestive of malignancy. Exploratory laparotomy revealed a large encapsulated mass from the greater omentum, and histopathology confirmed a diagnosis of high-risk extraluminal gastric GIST. The patient was successfully treated with surgical resection. This case highlights two important clinical issues. First, follow-up CT and FDG-PET/CT are useful in detecting GIST when an unexplained intraperitoneal hematoma is identified. Second, surgical intervention is recommended in such cases to determine the cause. Contrast-enhanced follow-up CT and FDG-PET/CT are valuable in clarifying the presence of GIST, and surgical intervention is recommended to identify the causes of intraperitoneal hematoma. Further studies are needed to standardize the approach to spontaneous hematoma from GIST.
自发性腹腔积血是一种罕见且可能危及生命的疾病，鉴别诊断范围广泛。胃肠道间质瘤（GIST）可表现为自发性腹腔积血，尽管由于其罕见性，将GIST诊断为腹腔积血的病因具有挑战性。一名76岁的日本男性因突发上腹部疼痛就诊，超声检查发现有一个10厘米的占位性病变和腹水。尽管生命体征稳定，但计算机断层扫描（CT）结果显示有一个10×15厘米的肿块，伴有实性和囊性成分不均匀强化的病变，患者选择了保守治疗。两个月后，增强CT扫描显示血肿内有一个高密度区域，促使进一步进行氟脱氧葡萄糖-正电子发射断层扫描/CT（FDG-PET/CT）检查，结果显示FDG摄取提示为恶性肿瘤。剖腹探查发现大网膜有一个巨大的包膜肿块，组织病理学确诊为高危腔外胃GIST。患者通过手术切除成功治愈。该病例突出了两个重要的临床问题。第一，当发现不明原因的腹腔内血肿时，随访CT和FDG-PET/CT有助于检测GIST。第二，对于此类病例，建议进行手术干预以确定病因。增强随访CT和FDG-PET/CT对于明确GIST的存在很有价值，建议进行手术干预以确定腹腔内血肿的原因。需要进一步研究来规范GIST自发性血肿的处理方法。
