title: Small bowel Gastrointestinal Stromal Tumors can physiologically alter gut motility before causing mechanical obstruction.
abstract: BACKGROUND
  Gastro Intestinal Stromal Tumors (GISTs) are rare stromal neoplasms that represent the most common mesenchymal tumor of the G.I. tract, accounting for 5% of all sarcomas. Originating from interstitial cells of Cajal, which are regulators of gut peristalsis, they are preferentially located in the stomach and the small intestine and clinical presentation is variable, ranging from vague complaints to major G.I. bleeding. Surgical resection is the mainstay of treatment for patients with resectable GIST and 5-year survival ranges from 21% to 88% in different series depending on risk grading and completeness of surgical resection. Imatinib mesylate, a tyrosine kinase inhibitor, provides an encouraging option for treating high risk GISTs.
  
  
  METHODS
  We report the case of a 62-year-old lady who had been diagnosed and being treated unsuccessfully for Irritable bowel syndrome for 11 years and eventually found to have an obstructing small bowel GIST.
  
  
  CONCLUSIONS
  The symptoms from GIST may mimic those of irritable bowel syndrome. A physiological alteration in gut peristalsis resulting from neoplastic transformation of the interstitial cells of Cajal, is a hypothesis that could explain this presentation. An alternative diagnosis should be considered when treating patients with irritable bowel syndrome who fail to respond for a prolonged period.
authors.affiliation: Specialist Registrar, General Surgery, Charing Cross Hospital, London W6 8RF, UK.
authors.forename: Manish S
authors.initials: MS
authors.lastname: Kothari
authors.affiliation: Senior House Officer, General Surgery, Watford General Hospital, Watford, WD18 0HB, UK.
authors.forename: Vasilis
authors.initials: V
authors.lastname: Kosmoliaptsis
authors.affiliation: Consultant Surgeon, General Surgery, Watford General Hospital, Vicarage Road, Watford, WD18 0HB, UK.
authors.forename: John
authors.initials: J
authors.lastname: Meyrick-Thomas