Spontaneous perforation of jejunal gastrointestinal stromal tumor: A case report

Abstract

Introduction: The incidence of small bowel tumors is comparatively rare when compared to colonic tumors. They comprise less than 10% of all gastrointestinal neoplasms. Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract; however it accounts for less than 1% of all gastrointestinal tumors.

Aim: To report a rare case of jejunal gastrointestinal stromal tumor presenting as a life-threatening emergency in a young adult male who was treated in the General Surgery department in the Jordanian Royal Medical Services (JRMS), Amman, Jordan.

Presented case: We report a 59-year-old male who presented to our emergency department with severe generalized abdominal pain. The patient was in a hypovolemic shock. Abdominal examination revealed a massively distended, tender abdomen. Abdomenal CT scan with IV contrast showed significant fat stranding around the jejunum associated with pneumoperitoneum and free fluid. Exploratory laparotomy was emergently performed, revealing diffuse peritonitis secondary to perforated small bowel tumor. En bloc resection was performed. Histopathologic examination confirmed the presence of malignant gastrointestinal stromal tumor of the jejunum with R0 clearance.

Discussion: Gastrointestinal stromal tumors are relatively rare and the jejunum is the least affected among other parts of the GI tract. The majority of ruptured GISTs occur spontaneously, and are located in the stomach and small bowel. Most ruptured GISTs are associated with dismal prognosis.

Conclusion: A jejunal gastrointestinal stromal tumor can rarely present with spontaneous perforation. However, it is important to highlight this condition, as early emergency intervention constitutes the key to a good outcome.

Keywords: Acute abdomen; Gastrointestinal stromal tumor; Perforation.