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Zhang W, Chen H, Zhu L, Kong Z, Wang T, Li W. Gastroduodenal intussusception caused by gastric gastrointestinal stromal tumor in adults: a case report and literature review. J Int Med Res 2022; 50:3000605221100772. [PMID: 35632985 PMCID: PMC9150259 DOI: 10.1177/03000605221100772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/26/2022] [Indexed: 11/18/2022] Open
Abstract
Intussusception mostly occurs in childhood and is rare in adults. Although intussusception can occur in any part of the gastrointestinal tract, gastroduodenal intussusception caused by a gastric tumor is relatively uncommon in clinical practice. A PubMed search identified 24 published cases of gastroduodenal intussusception caused by gastric gastrointestinal stromal tumor (GIST); however, it is possible that we missed other cases not included in PubMed. Here we report a case of gastroduodenal intussusception caused by gastric GIST in an 85-year-old man. He came to the hospital because of recurrent black stools. Plain computed tomography (CT) scan indicated a mass in the gastric antrum, with slight enhancement in the arterial phase on enhanced CT scan. He was diagnosed with GIST. In addition, images indicated that the mass overlapped into the duodenum, and gastroduodenal intussusception was thus considered. Gastroscopy showed a huge mass in the gastric body. According to the gastroscopy and CT results, gastroduodenal intussusception caused by a gastric tumor was considered. The patient underwent complete surgical removal, which revealed a mass originating from the gastric antrum and overlapping into the duodenum. The postoperative pathological diagnosis was intermediate-risk gastric GIST. The patient was followed up for 4 months without tumor recurrence.
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Affiliation(s)
- Wenbing Zhang
- Department of Gastrointestinal Surgery, the First People’s Hospital of Taicang City, Taicang Affiliated Hospital of Soochow University, Taicang City, Jiangsu Province, China
| | - Haifeng Chen
- Department of Gastroenterology, the First People’s Hospital of Taicang City, Taicang Affiliated Hospital of Soochow University, Taicang City, Jiangsu Province, China
| | - Lulu Zhu
- Department of Pathology, the First People’s Hospital of Taicang City, Taicang Affiliated Hospital of Soochow University, Taicang City, Jiangsu Province, China
| | - Zhiyuan Kong
- Department of Gastrointestinal Surgery, the First People’s Hospital of Taicang City, Taicang Affiliated Hospital of Soochow University, Taicang City, Jiangsu Province, China
| | - Tingting Wang
- Department of Nephrology, the First People’s Hospital of Taicang City, Taicang Affiliated Hospital of Soochow University, Taicang City, Jiangsu Province, China
| | - Weiping Li
- Department of Gastrointestinal Surgery, the First People’s Hospital of Taicang City, Taicang Affiliated Hospital of Soochow University, Taicang City, Jiangsu Province, China
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Hsieh YL, Hsu WH, Lee CC, Wu CC, Wu DC, Wu JY. Gastroduodenal intussusception caused by gastric gastrointestinal stromal tumor: A case report and review of the literature. World J Clin Cases 2021; 9:838-846. [PMID: 33585630 PMCID: PMC7852652 DOI: 10.12998/wjcc.v9.i4.838] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/19/2020] [Accepted: 12/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastric gastrointestinal stromal tumor (GIST) is the most common etiology of gastroduodenal intussusception. Although gastroduodenal intussusception caused by gastric GIST is mostly treated by surgical resection, the first case of gastroduodenal intussusception caused by gastric GIST was treated by endoscopic submucosal dissection (ESD) in Japan in 2017.
CASE SUMMARY An 84-year-old woman presented with symptoms of postprandial fullness with nausea and occasional vomiting for a month. Initially, she visited a local clinic for help, where abdominal sonography revealed a space-occupying lesion around the liver, so she was referred to our hospital for further confirmation. Abdominal sonography was repeated, which revealed a mass with an alternating concentric echogenic lesion. Esophagogastroduodenoscopy (EGD) was performed under the initial impression of gastric cancer with central necrosis and showed a tortuous distortion of gastric folds down from the lesser curvature side to the duodenal bulb with stenosis of the gastric outlet. EGD was barely passed through to the 2nd portion of the duodenum and a friable ulcerated mass was found. Several differential diagnoses were suspected, including gastroduodenal intussusception, gastric cancer invasion to the duodenum, or pancreatic cancer with adherence to the gastric antrum and duodenum. Abdominal computed tomography for further evaluation was arranged and showed gastroduodenal intussusception with a long stalk polypoid mass 5.9 cm in the duodenal bulb. Under the impression of gastroduodenal intussusception, ESD was performed at the base of the gastroduodenal intussusception; unfortunately, a gastric perforation was found after complete resection was accomplished, so gastrorrhaphy was performed for the perforation and retrieval of the huge polypoid lesion. The gastric tumor was pathologically proved to be a GIST. After the operation, there was no digestive disturbance and the patient was discharged uneventfully on the 10th day following the operation.
CONCLUSION We present the second case of gastroduodenal intussusception caused by GIST treated by ESD. It is also the first case report of gastroduodenal intussusception by GIST in Taiwan, and endoscopic reduction or resection is an alternative treatment for elderly patients who are not candidates for surgery.
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Affiliation(s)
- Yi-Lun Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Wen-Hung Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Ching-Chun Lee
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Chun-Chieh Wu
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Jeng-Yih Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
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Đokić M, Novak J, Petrič M, Ranković B, Štabuc M, Trotovšek B. Case report and literature review: patient with gastroduodenal intussusception due to the gastrointestinal stromal tumor of the lesser curvature of the gastric body. BMC Surg 2019; 19:158. [PMID: 31664984 PMCID: PMC6819360 DOI: 10.1186/s12893-019-0608-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/17/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Intussusception in adult patient is rare. Gastroduodenal intussusception due to the gastrointestinal stromal tumors is infrequently described in the literature. Authors present a case of gastroduodenal intussusception due to the low-risk gastrointestinal stromal tumor of the lesser curvature of the gastric body with literature review. CASE PRESENTATION Sixty-two-year-old male was admitted to our hospital with symptoms of acute gastric outlet obstruction. Imaging studies confirmed a lesion of the gastric wall producing gastroduodenal intussusception with pylorus obstruction. Upon laparotomy a tumor mass of the lesser curvature of the gastric body that invaginated through the pylorus into the duodenum was found. Desinvagination and resection of the tumor with the adequate resection margins were performed. Histology reveled a low-risk gastrointestinal stromal tumor. Due to favorable outcome only observation was suggested by the multidisciplinary team. CONCLUSIONS Gastroduodenal intussusception due to the gastrointestinal stromal tumor of the gastric wall is a rare event. Surgical resection is the treatment of choice. In selected cases laparosopic resection of the tumor can be performed.
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Affiliation(s)
- Mihajlo Đokić
- Department of Abdominal Surgery, Ljubljana University Medical Center, Zaloška cesta 7, 1000 Ljubljana, Slovenia
| | - Jerica Novak
- Department of Surgical Oncology, Ljubljana Institute of OncologyActa Chir Belg, Zaloška cesta 2, 1000 Ljubljana, Slovenia
| | - Miha Petrič
- Department of Abdominal Surgery, Ljubljana University Medical Center, Zaloška cesta 7, 1000 Ljubljana, Slovenia
| | - Branislava Ranković
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia
| | - Miha Štabuc
- Department of Radiology, Ljubljana University Medical Center, Zaloška cesta 7, 1000 Ljubljana, Slovenia
| | - Blaž Trotovšek
- Department of Abdominal Surgery, Ljubljana University Medical Center, Zaloška cesta 7, 1000 Ljubljana, Slovenia
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Ssentongo P, Egan M, Arkorful TE, Dorvlo T, Scott O, Oh JS, Amponsah-Manu F. Adult Intussusception due to Gastrointestinal Stromal Tumor: A Rare Case Report, Comprehensive Literature Review, and Diagnostic Challenges in Low-Resource Countries. Case Rep Surg 2018; 2018:1395230. [PMID: 30159192 PMCID: PMC6109502 DOI: 10.1155/2018/1395230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/16/2018] [Accepted: 07/08/2018] [Indexed: 12/19/2022] Open
Abstract
We present a rare case of gastrogastric intussusception due to gastrointestinal stromal tumor (GIST) and the largest comprehensive literature review of published case reports on gastrointestinal (GI) intussusception due to GIST in the past three decades. We found that the common presenting symptoms were features of gastrointestinal obstruction and melena. We highlight the diagnostic challenges faced in low-resource countries. Our findings emphasize the importance of early clinical diagnosis in low-resource settings in order to guide timely management. In addition, histological analysis of the tumor for macroscopic and microscopic characteristics including mitotic index and c-Kit/CD117 status should be obtained to guide adjuvant therapy with imatinib mesylate. Periodic follow-up to access tumor recurrence is fundamental and should be the standard of care.
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Affiliation(s)
- Paddy Ssentongo
- Center for Neural Engineering, Department of Engineering, Science and Mechanics, Pennsylvania State University, University Park, PA, USA
| | - Mark Egan
- Department of Pathology, Eastern Regional Hospital, P.O. Box 201, Koforidua, Ghana
| | - Temitope E. Arkorful
- Department of Surgery, Eastern Regional Hospital, P.O. Box 201, Koforidua, Ghana
| | - Theodore Dorvlo
- Department of Surgery, Eastern Regional Hospital, P.O. Box 201, Koforidua, Ghana
| | - Oneka Scott
- Ministry of Public Health, 1 Brickdam, Georgetown, Guyana
| | - John S. Oh
- Department of Surgery, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
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Yamauchi K, Iwamuro M, Ishii E, Narita M, Hirata N, Okada H. Gastroduodenal Intussusception with a Gastric Gastrointestinal Stromal Tumor Treated by Endoscopic Submucosal Dissection. Intern Med 2017; 56:1515-1519. [PMID: 28626176 PMCID: PMC5505906 DOI: 10.2169/internalmedicine.56.8160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/03/2016] [Indexed: 12/19/2022] Open
Abstract
A 95-year-old Japanese woman presented to our hospital with intermittent vomiting and several episodes of melena. Abdominal computed tomography revealed intussusception of the gastric tumor into the duodenum. After endoscopic reduction, endoscopic ultrasonography identified a hypoechogenic lesion limited to the submucosal layer. Endoscopic resection was performed as a localized treatment for the prevention of recurrent gastroduodenal intussusception. To our knowledge, there have been no other reports describing a gastric gastrointestinal stromal tumor presenting with gastroduodenal intussusception and treated using an endoscopic submucosal dissection technique.
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Affiliation(s)
- Kenji Yamauchi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | | | - Makoto Narita
- Department of Pathology, Kameda Medical Center, Japan
| | - Nobuto Hirata
- Department of Gastroenterology, Kameda Medical Center, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
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Gyedu A, Reich S, Hoyte-Williams P. Gastrointestinal Stromal Tumour Presenting Acutely as Gastroduodenal Intussusception. Acta Chir Belg 2016. [DOI: 10.1080/00015458.2011.11680764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A. Gyedu
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - S.B. Reich
- Meriter Hospital Pathology Department, Madison Wisconsin, USA
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Komatsubara T, Zuiki T, Lefor AK, Hirota N, Oki J. Unusual gastroduodenal intussusception secondary to a gastrointestinal stromal tumor of the gastric fundus. INTERNATIONAL JOURNAL OF SURGERY OPEN 2016. [DOI: 10.1016/j.ijso.2016.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Gastroduodenal intussusception of a gastrointestinal stromal tumor (GIST): case report and review of the literature. Surg Laparosc Endosc Percutan Tech 2013; 23:e70-3. [PMID: 23579533 DOI: 10.1097/sle.0b013e31826d72d4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in adults. They frequently occur in the stomach. Gastric GISTs typically present as a gastrointestinal bleed but can sometimes cause obstructive symptoms such as nausea and vomiting. We present a patient with a gastric GIST and liver metastases who during treatment with iminitab therapy presented with an acute gastric outlet obstruction. A computed tomography scan revealed a gastroduodenal intussusception of the gastric GIST. The patient underwent a laparoscopic exploration and resection of the GIST. We reviewed the English language literature of GISTs that presented as a gastroduodenal intussusception and put our case in the context of the previously reported cases. We discuss the diagnostic and therapeutic challenges that arise when treating these patients.
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Wang L, Fan CQ, Ren W, Zhang X, Li YH, Zhao XY. Endoscopic dissection of large endogenous myogenic tumors in the esophagus and stomach is safe and feasible: a report of 42 cases. Scand J Gastroenterol 2011; 46:627-33. [PMID: 21366494 DOI: 10.3109/00365521.2011.561364] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Submucosal myogenic tumors, including leiomyoma and stromal tumors, are currently treated primarily by open surgery or laparoscopic excision. The aim of this retrospective study was to evaluate the feasibility of endoscopic dissection (ED) for resecting endogenous esophageal leiomyoma (EL) and gastric stromal tumors (GSTs) with diameters of 5 cm. METHODS We enrolled 42 patients with endogenous EL and GST who had undergone endoscopic surgery (endoscopic group). These cases were compared retrospectively with 22 patients who had undergone thoracotomy or laparotomy (control group). Endoscopic group (n = 42) received ED for EL and GST resection, including circumferential removal of superficial mucosa of targeted tumor. Control group (n = 22) received thoracotomy or laparotomy for resection of esophageal and gastric myogenic tumors. Main outcome measures were operative time, intraoperative bleeding and perforation, postoperative complications, and hospital stays and costs were compared between groups. RESULTS Endogenous EL and GST were successfully removed from all patients. Bleeding and perforation occurred in seven and five EL and GST patients, respectively. Bleeding was corrected with argon plasma coagulation (APC). Perforation was endoscopically repaired with clips. Mean operative time was 49 min for endoscopic EL and 55 min for GST resection. No major bleeding or perforation occurred postoperatively. Endoscopic treatment had shorter length of stay and lower hospital costs than conventional procedures. CONCLUSIONS ED is safe and feasible for resection of endogenous EL and GST in selected cases.
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Affiliation(s)
- Lei Wang
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
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