A Case of a Ruptured Extramural Gastrointestinal Stromal Tumor of the Stomach with Intra-abdominal Hemorrhage

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  • 腹腔内出血を契機に発見された胃外発育性GISTの1例
  • 症例 腹腔内出血を契機に発見された胃外発育性GISTの1例
  • ショウレイ フクコウ ナイシュッケツ オ ケイキ ニ ハッケン サレタ イ ガイ ハツイクセイ GIST ノ 1レイ

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Abstract

<p>The case of a 59-year-old man with hemoperitoneum caused by rupture of an extramural gastrointestinal stromal tumor (GIST) of the stomach is reported. The patient presented with acute severe upper abdominal pain. Contrast-enhanced computed tomography showed intra-abdominal hemorrhage and solid mass lesions behind the stomach. The diagnosis was hemoperitoneum caused by rupture of a gastric submucosal tumor, and emergency surgery was performed. Intraoperative findings were a large amount of coagulated blood and ruptured tumors in the omental bursa. There was about 1200 ml of hemorrhagic ascites. Tumor was located on the posterior wall of the gastric body, and partial gastrectomy was performed. Histological examination showed that the tumor was gastric GIST, which was classified as high risk according to the modified Fletcher risk stratification. Since three years of adjuvant imatinib treatment is indicated for high-risk GIST, the patient was started on imatinib treatment one month after the surgery and is still alive without recurrence after three years of imatinib treatment. Hemoperitoneum caused by tumor rupture is a comparably rare finding of gastric GIST. Tumor rupture is one of the high-risk features for future recurrence or metastasis, including peritoneal dissemination ; therefore, cases with tumor rupture require ongoing watchful observation.</p>

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