Getting The Gist: An Unusual Presentation Of A Gastrointestinal Stromal Tumor
Gastrointestinal stromal tumors (GISTs) are common tumors of the gastrointestinal tract that derive from malignant precursors of the interstitial cells of Cajal affecting mostly middle aged to elderly patients. GIST's are most commonly found within the stomach in 60-70% of patient, while 25-35% are located in the small intestine. In 2018, a 50-year-old woman presented to an urgent care center for one day history of acute abdominal pain associated with nausea and emesis. An upright chest x-ray and abdominal x-ray demonstrated a free air under the diaphragm. The patient was transferred to the emergency department (ED). Presenting with tachycardia, hypotension, and diffuse right-sided tenderness, she was soon taken emergently to the operating room where she underwent a diagnostic laparoscopy that demonstrated a significant inflammation and contamination in the right side of the abdomen and pelvis secondary to perforated small bowel diverticulum, in the mesenteric side, 100 cm proximal to the cecum. She then underwent a segmental small bowel resection with adjacent mesentery and side-to-side functional end-to-end anastomosis. Pathology of the resected specimen showed a perforated small bowel diverticulum with a 2.7 x 2.5 cm gastrointestinal stromal tumor (GIST). Most of gastrointestinal stromal tumors (GISTs) are asymptomatic and usually found incidentally during endoscopic or surgical procedures. When symptomatic, these tumors usually present with an upper or lower GI bleeding, abdominal pain, or obstructive symptoms. This case illustrates a rare presentation of a GIST as a perforated diverticular structure of small bowel.