Gastrointestinal Stromal Tumors Presenting as Surgical Emergencies: A Six-Patient Case Series

Abstract

 Aim: To evaluate surgical and oncologic outcomes of patients who underwent urgent exploratory laparotomy, and successful surgical resection of gastrointestinal stromal tumors.

Methods: Medical records were retrospectively searched from January 2005 to January 2012 for cases with gastrointestinal stromal tumors, who had undergone urgent exploratory laparotomy.

Results: Of 51 patients operated for GISTs from January 2005 to January 2012, 6 cases had undergone urgent exploratory laparotomy and surgical resection. Our study group consisted of 4 female (66.6 %) and 2 male (33.4 %) patients with a median age of 60 years (range: 35-76 yrs). Their tumors were located in the stomach (n=1), jejunum (n=2), ileum (n=2), and rectum (n=1). For these tumors, total gastrectomy (n=1), segmental resection of the jejunum (n=2) or ileum (n=2), and left hemicolectomy (n=1) were performed followed by an uneventful postoperative course in all patients. According to Fletcher criteria, five tumors (83.3%) were classified as intermediate and high risk. No postoperative morbidity and mortality were noted. All patients received postoperative treatment with a tyrosine kinase inhibitor, imatinib. Median length of the hospital stay was 8 (range: 6 to 12) days. With a median follow-up of 32 (range 3 to 64) months, disease-free survival rate was 100 percent.

Conclusions: Although quite rare, patients with gastrointestinal stromal tumors may suffer from occult gastrointestinal hemorrhage and abdominal pain as the first clinical manifestations leading to urgent exploratory laparotomy and surgical extirpation of the tumor.