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Frontiers of Medicine

Front. Med.    2015, Vol. 9 Issue (1) : 108-111     DOI: 10.1007/s11684-014-0344-0
CASE REPORT |
A ruptured recurrent small bowel gastrointestinal stromal tumour causing hemoperitoneum
Eric C.H. Lai1,3,Kam Man Chung2,Stephanie H.Y. Lau4,Wan Yee Lau1,*()
1. Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
2. Dr. K.M. Chung’s Clinic, Rm 807, Hang Seng Tsimshatsui Building, 18 Carnarvon Road, Tsimshatsui, Hong Kong SAR, China
3. Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
4. Department of Surgery, Queen Elizabeth Hospital, Hong Kong SAR, China
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Abstract

Hemoperitoneum is a rare and potentially life-threatening complication of GIST. We reported a 54-year-old man who developed disseminated intra-abdominal recurrence from a previously resected gastrointestinal stromal tumour (GIST) of the small bowel, and the patient presented with hemoperitoneum. Emergent debulking surgery was performed. A high dose imatinib was prescribed. Despite the presence of residual disease, the patient was well clinically 8 months after the operation. Even though, there is no evidence to support the routine use of debulking surgery in the management of GIST. In our patient, disease progression after second line targeted therapy and the absence of alternative treatment options for spontaneous rupture and hemoperitoneum prompted us to treat the patient aggressively. Resection of the ruptured GIST was carried out for control of bleeding and to prevent recurrent bleeding in this patient with good surgical risks. During the treatment decision-making, the patient’s general condition, the risk of surgery and the extent of dissemination were taken into consideration. In this patient who presented with spontaneous rupture of a small intestinal GIST, the novel use of targeted therapy and aggressive surgical treatment produced reasonably good survival outcome.

Keywords gastrointestinal stromal tumour      hemoperitoneum      small bowel GIST      small bowel neoplasm      imatinib     
Corresponding Authors: Wan Yee Lau   
Online First Date: 04 July 2014    Issue Date: 02 March 2015
 Cite this article:   
Eric C.H. Lai,Kam Man Chung,Stephanie H.Y. Lau, et al. A ruptured recurrent small bowel gastrointestinal stromal tumour causing hemoperitoneum[J]. Front. Med., 2015, 9(1): 108-111.
 URL:  
http://journal.hep.com.cn/fmd/EN/10.1007/s11684-014-0344-0
http://journal.hep.com.cn/fmd/EN/Y2015/V9/I1/108
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Eric C.H. Lai
Kam Man Chung
Stephanie H.Y. Lau
Wan Yee Lau
Fig.1  18FDG-PET-computed tomography showed a 3 cm subcutaneous tumor nodule just beneath the umbilicus.
Fig.2  Tumour nodules in the pelvis.
Fig.3  Tumour nodules in the right subhepatic space.
Fig.4  Bluish discoloration of the umbilicus near the midline scar.
Fig.5  A ruptured GIST in the pelvis.
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