title: Hemoperitoneum caused by a ruptured GIST located in the posterior gastric wall managed by endoscopic diagnosis and laparoscopic treatment: case report and literature review.
abstract: A case of hemoperitoneum caused by a ruptured gastrointestinal stromal tumor (GIST) of the posterior gastric wall is presented. An otherwise healthy 81-year-old man presented with abdominal pain/tenderness and anemia (hemoglobin: 7.4 g/dL). Computed tomography scan showed hemoperitoneum and a gastric mass of uncertain nature. As the patient was hemodynamically stable, a mini-invasive approach was decided. Esophagogastroscopy revealed an umbilicated mass of the posterior gastric wall, therefore allowing for a correct preoperative diagnosis of GIST and its appropriate treatment by laparoscopic atypical gastrectomy. Laparoscopically, a longitudinal resection of gastric fundus including the tumor was performed in a sleeve gastrectomy fashion, 25 minutes after the induction of pneumoperitoneum. The outcome was uneventful. Pathologic examination confirmed a benign 4 × 3-cm gastric GIST with <1 mitosis per 50 high power field, staining positive for CD117 (C-KIT) and negative for S-100 protein and smooth muscle actin. To our knowledge, it is the first case of a successful laparoscopic resection of an endoscopically diagnosed gastric GIST in an emergency setting. Hemoperitoneum is a rare, potentially severe complication of GIST. As bleeding is rarely severe, most patients may benefit from a mini-invasive approach, even if the tumor is located in the posterior gastric wall.
authors.affiliation: Service de Chirurgie Digestive, Hôpital Antoine Béclère, Assistance Publique-Hopitaux de Paris, Université de Paris XI, Clamart, France. renatocosti@hotmail.com
authors.forename: Renato
authors.initials: R
authors.lastname: Costi
authors.forename: Alban
authors.initials: A
authors.lastname: Le Bian
authors.forename: Nicolas
authors.initials: N
authors.lastname: Creuze
authors.forename: Sophie
authors.initials: S
authors.lastname: Prevot
authors.forename: Francois
authors.initials: F
authors.lastname: Cauchy
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Violi
authors.forename: Claude
authors.initials: C
authors.lastname: Smadja
mesh_terms: D000369:Aged, 80 and over; D005743:Gastrectomy / Q000379:methods*; D046152:Gastrointestinal Stromal Tumors / Q000150:complications* / Q000601:surgery; D005773:Gastroscopy / Q000379:methods*; D006465:Hemoperitoneum / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012422:Rupture, Spontaneous / Q000150:complications; D013274:Stomach Neoplasms / Q000150:complications* / Q000601:surgery