A Case of Gastrointestinal Stromal Tumor of the Small Intestine with Melena and Perforatory Peritonitis

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  • HAYAMI Masaru
    Department of Surgery, Asakadai Central General Hospital Department of Surgery II, Tokyo Women′s Medical University, School of Medicine
  • FUJITA Ryoichi
    Department of Surgery, Asakadai Central General Hospital
  • MURATA Jun
    Department of Surgery, Asakadai Central General Hospital
  • KAMEOKA Shingo
    Department of Surgery II, Tokyo Women′s Medical University, School of Medicine

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Other Title
  • 下血と穿孔性腹膜炎にて発症した小腸ＧＩＳＴの１例
  • 胃がん
  • イガン

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A 73–year–old man with melena, fever and lower abdominal pain was found to have a palpable tumor and lower abdominal tendernes. Abdominal computed tomography (CT) showed a solid 14 cm tumor with bleeding, internal necrosis, and surrounded by air bubbles different from intestinal lumen. The tumor was fed from the jejunal artery. The size, location, and perforation suggested a gastrointestinal stromal tumor (GIST). Laparotomy confirmed a giant small intestine tumor adheding to the posterior bladder wall and retroperitoneum. Inflammatory change involved the appendix. We partially resected the small intestine including the tumor and part of the bladder wall, also conducting, appendectomy and drainage. Histopathological findings showed tumor cells positive for c–kit and confirming a definitive diagnosis of small intestinal GIST. Imatinib mesylate was started 8 months later as chemotherapy. No recurrence has been seen in the 21 months postoperatively.

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