Hemorragia de tubo digestivo secundaria a tumor del estroma gastrointestinal localizado en yeyuno. Reporte de un caso

Background

Gastrointestinal stromal tumours (GIST) are rare, with around 20% being located in the small intestine. The most common clinical presentation is gastrointestinal bleeding, resulting from pressure necrosis and ulceration of the gastrointestinal mucosa, with laceration of the underlying vessels.

Clinical case

A 37-year old male, with clinical symptoms of obscure gastrointestinal bleeding. The endoscopy and colonoscopy showed no abnormalities, and an abdominal-pelvic tomography demonstrated a small bowel loop with a possible GIST being likely, due to the persistent gastrointestinal bleeding. An exploratory laparotomy it is performed, finding a tumour in the jejunum. An intestinal resection and end-to-end intestinal anastomosis was performed. With normal post-operative course, the patient was discharged on the fifth day, with histopathology reporting fusiform tumour cells and positive CD117, compatible with a stromal tumour.

Discussion

GISTs are derived from Cajal cells, and are characterised by mutations of c-KIT gene. They represent less than 1% of all digestive tract tumours, and occur most often in the stomach, followed by the small intestine. Its most common clinical presentation is gastrointestinal bleeding, representing 5-10% of cases when the origin is obscure. Part of surgical recommendations in the curative treatment of GIST are complete resection with negative surgical margins and pseudo-capsule (R0).

Conclusions

GISTs are a cause of gastrointestinal bleeding of obscure origin, with complete surgical resection being the only curative option.