Acute Right Lower Abdomen in a Patient with a History of Gastrointestinal Stromal Tumor
Background. Gastrointestinal stromal tumor (GIST) is an uncommon tumor of the GI tract usually seen in elderly patients, often difficult to diagnose because of the unspecific symptoms such as abdominal pain and fullness. Recurrent GIST may have an even more obscure clinical presentation. Case Report...
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| Language: | English |
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Wiley
2019-01-01
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| Series: | Case Reports in Surgery |
| Online Access: | http://dx.doi.org/10.1155/2019/6091515 |
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| author | Dabanjan Bandyopadhyay Hugo J. R. Bonatti |
| author_facet | Dabanjan Bandyopadhyay Hugo J. R. Bonatti |
| author_sort | Dabanjan Bandyopadhyay |
| collection | DOAJ |
| description | Background. Gastrointestinal stromal tumor (GIST) is an uncommon tumor of the GI tract usually seen in elderly patients, often difficult to diagnose because of the unspecific symptoms such as abdominal pain and fullness. Recurrent GIST may have an even more obscure clinical presentation. Case Report. A 44-year-old female with a history of surgically treated GIST presented to the emergency room complaining of acute onset sharp RLQ pain, nausea, and vomiting. Clinically, she had RLQ tenderness with rebound, her WBC was elevated, and CT scan showed signs of appendicitis and also soft tissue masses suspicious for malignancy. After contemplating treatment options including antibiotics and further workup, it was recommended to proceed with surgery. Laparoscopy showed a thickened appendix with nodular infiltration and multiple mass-like lesions in the RLQ not amendable to minimal invasive resection. From a lower midline incision, an open appendectomy and excision of multiple masses in the terminal ileum and in the abdominal wall were done. Narrow-based Meckel’s diverticulum with multiple nodular lesions was also removed. Pathology identified appendicitis and serosal involvement of GIST in all specimens staining positive for CD68, CD117, and vimentin. The patient was started on imatinib and remained recurrence-free after 6 months. Conclusions. This case illustrates a rare presentation of acute symptomatic recurrent metastatic GIST. Our patient was unusually young, and GIST recurrence presented with acute RLQ pain suggestive for acute appendicitis and also involved Meckel’s diverticulum. Surgical debulking followed by imatinib seems to be a reasonable approach in such cases. |
| format | Article |
| id | doaj-art-e52ce1c16aec4cb9a4d9a8fb1be493d9 |
| institution | Kabale University |
| issn | 2090-6900 2090-6919 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Surgery |
| spelling | doaj-art-e52ce1c16aec4cb9a4d9a8fb1be493d92025-08-20T03:26:20ZengWileyCase Reports in Surgery2090-69002090-69192019-01-01201910.1155/2019/60915156091515Acute Right Lower Abdomen in a Patient with a History of Gastrointestinal Stromal TumorDabanjan Bandyopadhyay0Hugo J. R. Bonatti1University of Maryland Community Medical Group, Surgical Care, 500 Cadmus Lane, Easton, MD 21601, USAUniversity of Maryland Community Medical Group, Surgical Care, 500 Cadmus Lane, Easton, MD 21601, USABackground. Gastrointestinal stromal tumor (GIST) is an uncommon tumor of the GI tract usually seen in elderly patients, often difficult to diagnose because of the unspecific symptoms such as abdominal pain and fullness. Recurrent GIST may have an even more obscure clinical presentation. Case Report. A 44-year-old female with a history of surgically treated GIST presented to the emergency room complaining of acute onset sharp RLQ pain, nausea, and vomiting. Clinically, she had RLQ tenderness with rebound, her WBC was elevated, and CT scan showed signs of appendicitis and also soft tissue masses suspicious for malignancy. After contemplating treatment options including antibiotics and further workup, it was recommended to proceed with surgery. Laparoscopy showed a thickened appendix with nodular infiltration and multiple mass-like lesions in the RLQ not amendable to minimal invasive resection. From a lower midline incision, an open appendectomy and excision of multiple masses in the terminal ileum and in the abdominal wall were done. Narrow-based Meckel’s diverticulum with multiple nodular lesions was also removed. Pathology identified appendicitis and serosal involvement of GIST in all specimens staining positive for CD68, CD117, and vimentin. The patient was started on imatinib and remained recurrence-free after 6 months. Conclusions. This case illustrates a rare presentation of acute symptomatic recurrent metastatic GIST. Our patient was unusually young, and GIST recurrence presented with acute RLQ pain suggestive for acute appendicitis and also involved Meckel’s diverticulum. Surgical debulking followed by imatinib seems to be a reasonable approach in such cases.http://dx.doi.org/10.1155/2019/6091515 |
| spellingShingle | Dabanjan Bandyopadhyay Hugo J. R. Bonatti Acute Right Lower Abdomen in a Patient with a History of Gastrointestinal Stromal Tumor Case Reports in Surgery |
| title | Acute Right Lower Abdomen in a Patient with a History of Gastrointestinal Stromal Tumor |
| title_full | Acute Right Lower Abdomen in a Patient with a History of Gastrointestinal Stromal Tumor |
| title_fullStr | Acute Right Lower Abdomen in a Patient with a History of Gastrointestinal Stromal Tumor |
| title_full_unstemmed | Acute Right Lower Abdomen in a Patient with a History of Gastrointestinal Stromal Tumor |
| title_short | Acute Right Lower Abdomen in a Patient with a History of Gastrointestinal Stromal Tumor |
| title_sort | acute right lower abdomen in a patient with a history of gastrointestinal stromal tumor |
| url | http://dx.doi.org/10.1155/2019/6091515 |
| work_keys_str_mv | AT dabanjanbandyopadhyay acuterightlowerabdomeninapatientwithahistoryofgastrointestinalstromaltumor AT hugojrbonatti acuterightlowerabdomeninapatientwithahistoryofgastrointestinalstromaltumor |