Researchers from Japan reported the rare case of a patient with gastrointestinal stromal tumor (GIST) and small bowel torsion. The pedunculated tumor was twisted 360° at the pedicle, causing hemorrhage and necrosis.
The tumor and the small intestine were resected to treat the patient. The case report is published in the International Journal of Surgery Case Reports.
“Torsion of a pedunculated small intestine GIST, although very rare, requires emergency surgery and should be recognized as a cause of acute abdomen in patients with GIST,” the researchers said. “Immediate surgery is mandatory if torsion of a small intestinal GIST is suspected because the GIST or intestine may become necrotic owing to hemorrhagic infarction.”
Read more about the treatment of GIST
The case presented here is that of a patient who presented with lower abdominal pain. The patient was 69 years of age. Abdominal contrast-enhanced computed tomography revealed a tumor in her pelvic cavity with enhanced margins and reduced contrast, which led the doctors to think that the tumor had caused hemorrhagic infarction.
The patient was treated with laparotomy, which showed that the tumor was twisted 360° clockwise at the pedicle and that this torsion caused hemorrhage and necrosis.
The researchers then examined the tumor histopathologically and saw tightly arranged spindle-shaped cells with congestion, hemorrhage, and inflammatory cell infiltration. The cells were positive for CD34, CD117, and DOG1.
“If a GIST has torsion and ischemic necrosis, the tumor will have no contrast effect inside on CT,” the researchers concluded. “Prompt surgery is vital if torsion of a small intestinal GIST is suspected.”
GIST is the name given to mesenchymal tumors originating from the gastrointestinal tract wall. Around 20% to 30% of GISTs originate from the small intestine and generally present with a palpable mass, distention, and abdominal pain. They may also exhibit acute abdomen at the onset.
Yoshizawa JC, Shimizu T, Ikehara T, Fukushima K, Nakayama A. Gastrointestinal stromal tumor of the small bowel complicated by torsion: a case report. Int J Surg Case Rep. Published online October 22, 2022. doi:10.1016/j.ijscr.2022.107761