Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2021; 9(4): 838-846
Published online Feb 6, 2021. doi: 10.12998/wjcc.v9.i4.838
Gastroduodenal intussusception caused by gastric gastrointestinal stromal tumor: A case report and review of the literature
Yi-Lun Hsieh, Wen-Hung Hsu, Ching-Chun Lee, Chun-Chieh Wu, Deng-Chyang Wu, Jeng-Yih Wu
Yi-Lun Hsieh, Wen-Hung Hsu, Deng-Chyang Wu, Jeng-Yih Wu, 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
Author contributions: Hsieh YL drafted the manuscript, Hsu WH, Lee CC, Wu CC, and Wu DC acquired and analyzed the data; Wu JY revised the manuscript critically for important intellectual content; all authors have read and approved the final manuscript.
Informed consent statement: The patient provided informed written consent for the publication of this case report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jeng-Yih Wu, MD, Professor, Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100 Tz-You 1st Road, Kaohsiung 807, Taiwan. joywu@kmu.edu.tw
Received: August 25, 2020
Peer-review started: August 25, 2020
First decision: November 8, 2020
Revised: November 19, 2020
Accepted: December 10, 2020
Article in press: December 10, 2020
Published online: February 6, 2021
Processing time: 145 Days and 4.5 Hours
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.

Keywords: Gastric gastrointestinal stromal tumor; Endoscopic submucosal dissection; Gastro-duodenal intussusception; Elderly; Esophagogastroduodenoscopy; Gastrointestinal obstruction; Case report

Core Tip: This is the first case report of gastroduodenal intussusception caused by gastrointestinal stromal tumor in Taiwan and endoscopic reduction or resection is an alternative treatment for elderly patients who are not candidates for surgery.