title: Peritonitis secondary to spontaneous perforation of a primary gastrointestinal stromal tumour of the small intestine: A case report and a literature review.
abstract: BACKGROUND
  A few cases of acute abdomen caused by perforation of small-intestinal gastrointestinal stromal tumours (GISTs) have been reported in the literature.
  
  
  METHODS
  Together with a review of the published cases, here we report a case of an elderly patient with peritonitis due to spontaneous perforation of a GIST of the jejunum. An 82-year-old man was admitted to the emergency unit of our hospital with fever and severe abdominal pain. An abdominal enhanced computed tomography scan detected a 6cm solid mass in the left upper quadrant adherent to a jejunal loop and surrounded by free fluid and free air. Due to the radiological features of the mass, the diagnosis of a perforation of a GIST arising from the jejunum wall was suspected. The patient underwent emergency laparotomy. Intraoperative findings confirmed diffuse peritonitis secondary to jejunal tumour perforation. A segmental resection of the jejunum containing the mass was performed followed by a mechanical end-to-side anastomosis. The histopathologic examination of the mass confirmed the diagnosis of a perforated GIST of the small intestine (high-risk category). The post-operative course was uneventful and the patient was treated with adjuvant imatinib therapy.
  
  
  CONCLUSIONS
  Twenty-one other cases of spontaneous perforation of small intestine GISTs are reported in the literature and are summarized in the present review.
  
  
  CONCLUSIONS
  The described case is the tip of the iceberg and spontaneous rupture or perforation of GISTs are a far more frequent first presentation of this rare tumour.
authors.affiliation: Department of General Surgery, Varzi Hospital, Italy; Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Alessiani
authors.affiliation: Department of General Surgery, Varzi Hospital, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Gianola
authors.affiliation: Radiology Service, Voghera Hospital, Italy.
authors.forename: Sabina
authors.initials: S
authors.lastname: Rossi
authors.affiliation: Department of Oncology, IRCCS San Matteo Hospital Foundation, Pavia, Italy. Electronic address: v.perfetti@smatteo.pv.it.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Perfetti
authors.affiliation: Department of General Surgery, Varzi Hospital, Italy. Electronic address: piero_serra@ospedali.pavia.it.
authors.forename: Piero
authors.initials: P
authors.lastname: Serra
authors.affiliation: Department of General Surgery, Varzi Hospital, Italy. Electronic address: daniela_zelaschi@ospedali.pavia.it.
authors.forename: Daniela
authors.initials: D
authors.lastname: Zelaschi
authors.affiliation: Department of General Surgery, Varzi Hospital, Italy. Electronic address: enzo_magnani@ospedali.pavia.it.
authors.forename: Enzo
authors.initials: E
authors.lastname: Magnani
authors.affiliation: Unit of General Surgery 1, IRCCS San Matteo Hospital Foundation, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Italy. Electronic address: l.cobianchi@smatteo.pv.it.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Cobianchi
keywords: Gastrointestinal stromal tumours; Peritonitis; Small intestine