title: Enteroscopic Tattooing for Better Intraoperative Localization of a Bleeding Jejunal GIST Facilitates Minimally Invasive Laparoscopically-assisted Surgery.
abstract: We present the case of a 63-year-old man that was admitted for melena and severe anemia. Upper GI endoscopy and colonoscopy failed to identify the lesion responsible for bleeding, and enteroCT scan was also non-contributive to the diagnosis. Capsule endoscopy indicated possible jejunal bleeding but could not indicate the source of bleeding, recommending anterograde enteroscopy. Single balloon enteroscopy identified a 2 cm submucosal tumour in the distal part of the jejunum, with a macroscopic appearance suggesting a gastrointestinal stromal tumour (GIST). The tumor location was marked using SPOT tattoo and subsequently easily identified by the surgeon and resected via minimally invasive laparoscopic-assisted approach. Histological and immunohistochemical analysis indicated a low risk GIST. The unusual small size of the GIST as a modality of presentation, with digestive bleeding and anemia and the ability to use VCE/enteroscopy to identify and mark the lesion prior to minimally invasive surgery, represent the particularities of the presented case.
authors.affiliation: Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania.
authors.forename: Razvan
authors.initials: R
authors.lastname: Iacob
authors.affiliation: Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania.
authors.forename: Anca
authors.initials: A
authors.lastname: Dimitriu
authors.affiliation: Dan Setlacec Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
authors.forename: Oana
authors.initials: O
authors.lastname: Stanciulea
authors.affiliation: Department of Pathology, Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest, Romania.
authors.forename: Vlad
authors.initials: V
authors.lastname: Herlea
authors.affiliation: Dan Setlacec Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
authors.forename: Irinel
authors.initials: I
authors.lastname: Popescu
authors.affiliation: Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania. drgheorghe@xnet.ro.
authors.forename: Cristian
authors.initials: C
authors.lastname: Gheorghe
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D058582:Double-Balloon Enteroscopy; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D046152:Gastrointestinal Stromal Tumors / Q000737:chemistry / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007150:Immunohistochemistry; D007430:Intraoperative Care; D007580:Jejunal Neoplasms / Q000737:chemistry / Q000150:complications / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D000071085:Single-Balloon Enteroscopy; D013653:Tattooing; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor