Treatment of gastric gastrointestinal stromal tumor by laparoscopic sleeve gastrectomy in a morbidly obese patient

Obesity is a chronic disease with increasing rates of morbidity and mortality, and it significantly affects public health. Bariatric surgical methods, particularly laparoscopic sleeve gastrectomy (LSG), provide effective weight loss and control (1). Patients should be examined with respect to concomitant pathologies before LSG. In particular, gastric pathologies may alter the surgical procedure. Two-thirds of the gastrointestinal stromal tumors develop in the stomach (2). Such slowly-growing sub-mucosal tumors can occasionally ulcerate and result in bleeding, but in most cases they are only incidentally identified. Very large lesions may result in abdominal pain, a sense of fullness and weight loss. While endoscopy and biopsy are crucial for diagnosis, endoscopic ultrasonography (EUS) may also be helpful. Computerized tomography of the abdomen, pelvis and thorax is crucial to identify metastases and the primary tumor. In such tumors, wedge resection with clean borders is the adequate method of surgical therapy (3). While there is no known relation between gastrointestinal stromal tumors (GIST) and obesity, patients should be examined before bariatric surgery in terms of lesions that may have an asymptomatic course, such as GIST, lymphoma and leiomyoma. Several studies have reported that GIST-like pathologies may be detected during bariatric surgery procedures or postoperative histopathological examinations of the resected gastric specimen (4). A 57 years-old male patient was admitted to our clinics for a planned LSG due to morbid obesity. His body weight was 153 kg and height was 164 cm, his BMI was calculated as 56.6 kg/m2. Upper gastrointestinal system endoscopy indicated chronic active gastritis and an abdominal ultrasonography was performed as the patient reported abdominal pain. Ultrasonography showed cholelithiasis and a mass with an unclear origin located in the epigastric region of the posterior aspect of anterior abdominal wall. Abdominal magnetic resonance imaging showed a mass originating from the stomach wall, starting from the antrum with an anterior superior exophytic extension towards the large curvature. The mass was measured as 90 x 50 x 53 mm at the most pronounced position and it was found to be consistent with GIST (Figure 1-2).