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Diagnostic and Therapeutic Challenges in the Management of Acute Massive Overt Bleeding of Jejunal Gastrointestinal Stromal Tumours: Case Series

  • Mgmt. of Complex Cases in GI Oncology
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Abstract

Introduction

Jejunal gastrointestinal stromal tumours (GIST) are rare mesenchymal tumours. Acute massive overt bleeding from jejunal GIST is very rare and poses both diagnostic and therapeutic challenges in emergent conditions.

Methods

A case series with retrospective analysis of prospectively maintained database of patients presenting with acute massive overt bleeding secondary to histologically proven jejunal GIST was done. Clinical characteristics, endoscopic and imaging diagnostic features, histological findings, surgical procedures and outcomes in these patients were studied.

Results

Three patients were included in this case series. Mean age of presentation was 49.0 years with two male and one female patient. All three patients presented with melena and hemodynamic instability, resuscitated with adequate blood transfusions. Routine endoscopic assessment were inconclusive. Multiphasic Computed Tomographic Angiography (CTA) revealed hypodense hypervascular mass in jejunum in all three patients. One patient was unresponsive to blood transfusion and underwent emergency exploratory laparotomy. One patient underwent laparoscopic resection and reconstruction. Mean length of hospital stay was 5.3 days. Histopathological examination confirmed jejunal GIST in all three patients with microscopically negative resection margins. Two patients were disease free till 18-month follow-up and the one patient lost to follow-up after 1 year.

Conclusion

Multiphasic CTA is a single-step diagnostic tool for localisation of bleed and assessment of tumour characteristics in emergent conditions. Surgical resection is the mainstay of treatment for both control of bleed and to provide oncologically clear resection margins.

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Authors and Affiliations

  1. Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Satish Subbiah Nagaraj, Sriram Deivasigamani, Amresh Aruni & Hemanth Kumar

  2. Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Anurag Sachan & Jayanta Samanta

  3. Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Amanjit Bal

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  1. Satish Subbiah Nagaraj
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  2. Sriram Deivasigamani
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  3. Amresh Aruni
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  4. Hemanth Kumar
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Contributions

Satish Subbiah Nagaraj and Hemanth Kumar contributed to the study conception and design. Material preparation, data collection, analysis and first draft of the manuscript were written by Satish Subbiah Nagaraj, Sriram Deivasigamani, Amresh Aruni and Anurag Sachan. Manuscript review, editing, supervision and final approval was done by Satish Subbiah Nagaraj, Hemanth Kumar, Jayanta Samata and Amanjit Bal.

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Correspondence to Hemanth Kumar.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Written informed consent for the paper to be published (including images, case history and data) was obtained from the patient/guardian for publication of this paper, including accompanying images.

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The authors declare no competing interests.

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Nagaraj, S.S., Deivasigamani, S., Aruni, A. et al. Diagnostic and Therapeutic Challenges in the Management of Acute Massive Overt Bleeding of Jejunal Gastrointestinal Stromal Tumours: Case Series. J Gastrointest Canc 54, 316–322 (2023). https://doi.org/10.1007/s12029-021-00650-w

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