Perforated Gastrointestinal Stromal Tumor of the Meckel's Diverticulum: a Case Report and Review of Literature

Utility of Follow-Up Computed Tomography (CT) and Fluorodeoxyglucose-Positron Emission Tomography/CT (FDG-PET/CT) in Diagnosing Gastrointestinal Stromal Tumor (GIST) Presenting as Spontaneous Hemoperitoneum: A Case Report

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.

Bleeding From a Ruptured, Extraluminally Growing Gastric Gastrointestinal Stromal Tumor Treated by Transcatheter Arterial Embolization: A Case Report

A 49-year-old man with abdominal pain was referred to our hospital. Abdominal computed tomography showed an extraluminal tumor near the gastric anterior wall and intra-abdominal fluid collection. A ruptured intra-abdominal tumor was suspected, and emergency abdominal angiography was performed. Hemorrhage into the abdominal cavity was seen, and transcatheter arterial embolization (TAE) was performed, which stopped the bleeding. The tumor was surgically resected, and a diagnosis of an extraluminally growing gastric gastrointestinal stromal tumor was made. TAE should be considered for rare cases of extraluminally growing tumors with intra-abdominal hemorrhage.

Gastrointestinal stromal tumor in ruptured Meckel's diverticulum located in jejunum caused myelosuppression for a short time: A case report

INTRODUCTION AND IMPORTANCE

Gastrointestinal stromal tumor (GIST) in Meckel's diverticulum (MD) is rare but it seems to be a common phenomenon that GIST triggers MD perforation or rupture; the exact mechanism is unclear. In addition, the location of GIST in perforated or ruptrued MD is most common in ileum, rarely in jejunum. We herein report a GIST in ruptured MD Located in jejunum and severe peritoneal cavity infection leads to myelosuppression.

CASE PRESENTATION

A female patient was admitted to our hospital with "abdominal pain". Physical examination and laboratory tests revealed that the patient was in shock and myelosuppression. Abdominal X-ray photograph and computed tomography indicated perforation of digestive tract. Laparotomy revealed rupture of MD located 90 cm from the Treitz ligament and a tumor was also found in the MD. As the condition is critical, the MD was excisioned from its root and the small bowel gap was closed and repaired. Laboratory indicators showed that myelosuppression was removed 24 h after operation. The pathological findings established a GIST in the MD. The patient was discharged on postoperative day 5 without significant complications.

CLINICAL DISCUSSION

A GIST in ruptured MD Located in jejunum caused the severe peritoneal cavity infection and myelosuppression In a short time, as seen in this case. Failure to recognize the severity of the disease and delay in treatment will endanger the life of the patient.

CONCLUSION

GIST in MD Located in jejunum is very rare, and the rupture of the MD can be life-threatening at any time.

Co-Incidence of Paraesophageal Hernia and Perforated Gastrointestinal Stromal Tumor: A Case Report on Rare Presentation of GIST

Introduction: The most common connective tissue neoplasm of the gastrointestinal tract is gastrointestinal stromal tumors (GISTs). Its presentations are usually abdominal pain and gastrointestinal bleeding. Case Presentation: We report a 31-year-old man with abdominal pain presented to our hospital with 10 days history of abdominal pain. After radiologic investigations, total distended stomach paraesophageal hernia and antral deformity were seen in the CT scan. Subsequently, the patient underwent surgery and after releasing the stomach, a large sealed perforated mass was seen in the antrum near the diaphragmatic hiatus and small localized abscess that subtotal gastrectomy and hernia repair was done. Pathologic examination revealed that the perforated mass is a GIST. Conclusions: We report a rare complication of gist that is perforation and the first report of simultaneous paraesophageal hernia and perforated gist.

Gastrointestinal stromal tumor in perforated Meckel's diverticulum: a case report and literature review

Introduction

Gastrointestinal stromal tumor (GIST) is rare neoplasms of the gastrointestinal tract associated with high rates of malignant transformation. GIST has been found largely in the stomach, small bowel, colon and rectum, and esophagus, but about 5% are found in other locations. We herein report a 56-year-old woman with a GIST in perforated Meckel's diverticulum. After encountering this patient, a review of the literature found reports of 18 similar patients.

Case presentation

A 56-year-old woman diagnosed with galactosialidosis (β-galactosidase-neuraminidase deficiency) presented with vomiting. On contrast-enhanced computed tomography, peritonitis due to perforation of the intestine was diagnosed based on the free air and dilated loop of the small bowel. Laparotomy revealed perforation of Meckel’s diverticulitis located 50 cm from the ileocecal valve. Partial resection of the ileum, including the diverticulum, and end-to-end anastomosis of the small intestine were performed. Regarding the pathological findings, the edge of the diverticulum wall consisted of a solid mass measuring 1.0 cm in size, and the tumor cells were spindle-shaped with 1 mitosis present per 50 high-power fields. The diagnosis was established as GIST of the Meckel's diverticulum. The postoperative period was uneventful. Follow-up at two years revealed no evidence of recurrence.

Conclusion

GIST in perforated Meckel's diverticulum is very rare. The potential for the coexistence of GIST or other tumor should be considered in the treatment of perforated Meckel's diverticulum.