title: A ruptured recurrent small bowel gastrointestinal stromal tumour causing hemoperitoneum.
abstract: Hemoperitoneum is a rare and potentially life-threatening complication of GIST. We reported a 54-year-old man who developed disseminated intra-abdominal recurrence from a previously resected gastrointestinal stromal tumour (GIST) of the small bowel, and the patient presented with hemoperitoneum. Emergent debulking surgery was performed. A high dose imatinib was prescribed. Despite the presence of residual disease, the patient was well clinically 8 months after the operation. Even though, there is no evidence to support the routine use of debulking surgery in the management of GIST. In our patient, disease progression after second line targeted therapy and the absence of alternative treatment options for spontaneous rupture and hemoperitoneum prompted us to treat the patient aggressively. Resection of the ruptured GIST was carried out for control of bleeding and to prevent recurrent bleeding in this patient with good surgical risks. During the treatment decision-making, the patient's general condition, the risk of surgery and the extent of dissemination were taken into consideration. In this patient who presented with spontaneous rupture of a small intestinal GIST, the novel use of targeted therapy and aggressive surgical treatment produced reasonably good survival outcome.
authors.affiliation: Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
authors.forename: Eric C H
authors.initials: EC
authors.lastname: Lai
authors.forename: Kam Man
authors.initials: KM
authors.lastname: Chung
authors.forename: Stephanie H Y
authors.initials: SH
authors.lastname: Lau
authors.forename: Wan Yee
authors.initials: WY
authors.lastname: Lau
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D001549:Benzamides / Q000008:administration & dosage*; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D018450:Disease Progression; D004210:Dissection / Q000009:adverse effects* / Q000379:methods; D004305:Dose-Response Relationship, Drug; D005770:Gastrointestinal Neoplasms / Q000473:pathology / Q000601:surgery; D046152:Gastrointestinal Stromal Tumors / Q000473:pathology / Q000601:surgery; D006465:Hemoperitoneum / Q000209:etiology / Q000601:surgery; D006801:Humans; D000068877:Imatinib Mesylate; D007421:Intestine, Small / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000601:surgery; D010879:Piperazines / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000188:drug therapy / Q000601:surgery; D011743:Pyrimidines / Q000008:administration & dosage*; D018570:Risk Assessment; D012422:Rupture, Spontaneous
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate