Stromal Tumor of the Jejunum Complicated by Hemorrhagic Shock-A Case Report
Y. Fahmi *
Service Visceral Surgical Emergencies (P35), CHU Ibn Rushd, Department of Surgery, Hassan II University, Casablanca, Morocco.
A. El Bakouri
Service Visceral Surgical Emergencies (P35), CHU Ibn Rushd, Department of Surgery, Hassan II University, Casablanca, Morocco.
D. Khaiz
Service Visceral Surgical Emergencies (P35), CHU Ibn Rushd, Department of Surgery, Hassan II University, Casablanca, Morocco.
F. Z. Bensardi
Service Visceral Surgical Emergencies (P35), CHU Ibn Rushd, Department of Surgery, Hassan II University, Casablanca, Morocco.
K. Hattabi
Service Visceral Surgical Emergencies (P35), CHU Ibn Rushd, Department of Surgery, Hassan II University, Casablanca, Morocco.
S. Berrada
Service Visceral Surgical Emergencies (P35), CHU Ibn Rushd, Department of Surgery, Hassan II University, Casablanca, Morocco.
R. Lefriyekh
Service Visceral Surgical Emergencies (P35), CHU Ibn Rushd, Department of Surgery, Hassan II University, Casablanca, Morocco.
N. Benissa
Service Visceral Surgical Emergencies (P35), CHU Ibn Rushd, Department of Surgery, Hassan II University, Casablanca, Morocco.
A. Fadil
Service Visceral Surgical Emergencies (P35), CHU Ibn Rushd, Department of Surgery, Hassan II University, Casablanca, Morocco.
N. Zerouali
Service Visceral Surgical Emergencies (P35), CHU Ibn Rushd, Department of Surgery, Hassan II University, Casablanca, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Stromal tumors of the small bowel, commonly known as GIST (Gastrointestinal Stromal Tumors) are mesenchymal tumors of uncertain prognosis. They develop in the wall of the digestive tract. They are usually asymptomatic, incidentally discovered during endoscopy or during surgery. Identifying gastrointestinal stromal tumor is facilitated by a relatively specific marker, c-kit. Diagnosis is confirmed by histological examination of the surgical specimen. They pose two problems first is to confirm the diagnosis and second problem is to assess their evolutionary potential and customize the therapeutic management.
We report the case of a patient aged 34 years with no history of prior illness. He was admitted a year ago in the emergency room in a state of hemorrhagic shock due to lower gastro intestinal (GI) bleeding for three days. The patient underwent conservative therapy with I.V fluids and blood transfusions. An endoscopic assessment consisting of upper and lower GI(UGIE and colonoscopy) was done but that did not reveal any abnormalities.
Surgical exploration revealed a tumor 1 meter distal to the ligament of Treitz. Rest of the exploration was unremarkable. The tumor along with small bowel was resected and end to end anastomosis was performed. The postoperative course was uneventful.
Histological study of the surgical specimen confirmed that this was a stromal tumor with low potential of malignancy. The staging did not reveal any secondary lesions. Stromal tumors are often asymptomatic, lower GI bleeding is an exceptional way of presentation. Complete resection of the tumor is the treatment of choice. The recent development of targeted therapies and molecular biology is a new hope in the treatment of these tumors. The aim of this case study is to review the diagnostic and therapeutic aspects of this disease, and explain that hemorrhagic shock can be due to jejunal stromal tumor.
Keywords: Small bowel, lower GI bleeding, c-kit, imatinib, GIST.