A ruptured recurrent small bowel gastrointestinal stromal tumour causing hemoperitoneum

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

References

[1] Lai EC, Lau SH, Lau WY. Current management of gastrointestinal stromal tumors—a comprehensive review. Int J Surg2012; 10(7): 334–340

[2] Sorour MA, Kassem MI, Ghazal AH, El-Riwini MT, Abu Nasr A. Gastrointestinal stromal tumors (GIST) related emergencies. Int J Surg2014; 12(4): 269–280

[3] Marano L, Antonio Arru GM, Piras M, Gemini S. Surgical management of acutely presenting gastrointestinal stromal tumors of the stomach among elderly: Experience of an emergency surgery department. Int J Surg. 2014 May 22. [Epub ahead of print] doi: 10.1016/j.ijsu.2014.05.025

[4] Hirasaki S, Fujita K, Matsubara M, Kanzaki H, Yamane H, Okuda M, Suzuki S, Shirakawa A, Saeki H. A ruptured large extraluminal ileal gastrointestinal stromal tumor causing hemoperitoneum. World J Gastroenterol2008; 14(18): 2928–2931

[5] Mahmoud A, Fadhel F, Amin M, Wael R, Amin D, Haykel B, Faouzi C, Rachid K, Mohamed J, Montasser K, Zoubeir BS. A ruptured ileal GI stromal tumor causing hemoperitoneum. Gastrointest Endosc2010; 71(1): 185–186, discussion 186

[6] Pantaleo MA, Di Battista M, Catena F, Astorino M, Saponara M, Di Scioscio V, Santini D, Piazzi G, Castellucci P, Brandi G, Biasco G. Surgical debulking of gastrointestinal stromal tumors: is it a reasonable option after second-line treatment with sunitinib? J Cancer Res Clin Oncol2008; 134(5): 625–630

[7] Tielen R, Verhoef C, van Coevorden F, Gelderblom H, Sleijfer S, Hartgrink HH, Bonenkamp JJ, van der Graaf WT, de Wilt JH. Surgical treatment of locally advanced, non-metastatic, gastrointestinal stromal tumours after treatment with imatinib. Eur J Surg Oncol2013; 39(2): 150–155

[8] Bauer S, Rutkowski P, Hohenberger P, Miceli R, Fumagalli E, Siedlecki JA, Nguyen BP, Kerst M, Fiore M, Nyckowski P, Hoiczyk M, Cats A, Casali PG, Treckmann J, van Coevorden F, Gronchi A. Long-term follow-up of patients with GIST undergoing metastasectomy in the era of imatinib — analysis of prognostic factors (EORTC-STBSG collaborative study). Eur J Surg Oncol2014; 40(4): 412–419

[9] Pantaleo MA, Di Battista M, Catena F, Astorino M, Saponara M, Di Scioscio V, Santini D, Piazzi G, Castellucci P, Brandi G, Biasco G. Surgical debulking of gastrointestinal stromal tumors: is it a reasonable option after second-line treatment with sunitinib? J Cancer Res Clin Oncol2008; 134(5): 625–630

[10] Ruka W, Rutkowski P, Szawłowski A, Nowecki Z, Debiec-Rychter M, Grzesiakowska U, Dziewirski W, Siedlecki JA, Michej W. Surgical resection of residual disease in initially inoperable imatinib-resistant/intolerant gastrointestinal stromal tumor treated with sunitinib. Eur J Surg Oncol2009; 35(1): 87–91

[11] Mullady DK, Tan BR. A multidisciplinary approach to the diagnosis and treatment of gastrointestinal stromal tumor. J Clin Gastroenterol2013; 47(7): 578–585

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2014 Higher Education Press and Springer-Verlag Berlin Heidelberg