Enteroscopic Tattooing for Better Intraoperative Localization of a Bleeding Jejunal GIST Facilitates Minimally Invasive Laparoscopically-assisted Surgery

J Gastrointestin Liver Dis. 2016 Mar;25(1):105-8. doi: 10.15403/jgld.2014.1121.251.gst.

Abstract

We present the case of a 63-year-old man that was admitted for melena and severe anemia. Upper GI endoscopy and colonoscopy failed to identify the lesion responsible for bleeding, and enteroCT scan was also non-contributive to the diagnosis. Capsule endoscopy indicated possible jejunal bleeding but could not indicate the source of bleeding, recommending anterograde enteroscopy. Single balloon enteroscopy identified a 2 cm submucosal tumour in the distal part of the jejunum, with a macroscopic appearance suggesting a gastrointestinal stromal tumour (GIST). The tumor location was marked using SPOT tattoo and subsequently easily identified by the surgeon and resected via minimally invasive laparoscopic-assisted approach. Histological and immunohistochemical analysis indicated a low risk GIST. The unusual small size of the GIST as a modality of presentation, with digestive bleeding and anemia and the ability to use VCE/enteroscopy to identify and mark the lesion prior to minimally invasive surgery, represent the particularities of the presented case.

Publication types

  • Case Reports

MeSH terms

  • Biomarkers, Tumor / analysis
  • Biopsy
  • Double-Balloon Enteroscopy*
  • Gastrointestinal Hemorrhage / diagnosis
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / surgery*
  • Gastrointestinal Stromal Tumors / chemistry
  • Gastrointestinal Stromal Tumors / complications
  • Gastrointestinal Stromal Tumors / pathology
  • Gastrointestinal Stromal Tumors / surgery*
  • Humans
  • Immunohistochemistry
  • Intraoperative Care
  • Jejunal Neoplasms / chemistry
  • Jejunal Neoplasms / complications
  • Jejunal Neoplasms / pathology
  • Jejunal Neoplasms / surgery*
  • Laparoscopy*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Single-Balloon Enteroscopy*
  • Tattooing*
  • Treatment Outcome

Substances

  • Biomarkers, Tumor