Spontaneous hemoperitoneum secondary to a ruptured gastric stromal tumour

Initial presentation of a giant gastrointestinal stromal tumour of the stomach with recurrent spontaneous intra-peritoneal haemorrhage

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Gastrointestinal stromal tumours (GIST) are rare tumours of the digestive tract.

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Only reported gastric GIST with chronic spontaneous intraperitoneal hemorrhage.

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GIST recurrence after surgery is associated with a high tumour mitotic rate.

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Surgery is the mainstay of treatment.

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Tyrosine kinase inhibitors are associated with higher survival rates.

Introduction

Gastrointestinal stromal tumours are a rare group of tumours of the digestive tract. In the majority of cases, at the time of the diagnosis, tumours are usually small and patients are asymptomatic or have non-specific symptoms. The occurrence of digestive haemorrhage is relatively common; however, the manifestation with a spontaneous hemoperitoneum is extremely rare, specially if chronic and non-emergent.

Case report

We report an unusual case of a 65-year-old man with a history of alcohol abuse, presenting with abdominal distension due to ascites and a constitutional syndrome. He was found to have a gastrointestinal stromal tumour (GIST) of the stomach associated with a chronic hemoperitoneum, due to recurrent spontaneous haemorrhage. In an elective setting, the lesion was resected completely without rupturing the tumour pseudo-capsule and the patient had an uneventful postoperative course. The tumour was classified as a moderate-risk lesion for aggressive biological behaviour, and imatinib mesylate was initiated as an adjuvant to treatment. No evidence of disease recurrence after one year was noted.

Discussion and conclusion

GISTs are uncommon and rarely present with spontaneous intra-peritoneal haemorrhage, which may be life threatening. In our understanding, this is the first reported case of the reviewed literature presenting with a chronic hemoperitoneum, due to recurrent brisk episodes of tumour haemorrhage. Tumour rupture and large tumour size are two poor independent prognostic tumour factors for recurrence. Despite this, the patient remains free of disease after surgery and instituted adjuvant imatinib mesylate.