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129. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

24.04. - 27.04.2012, Berlin

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Large duodenal GIST tumor: case report of a rare entity and therapeutic consequences

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  • Katharina Pimpl - Krankenhaus der Barmherzigen Brüder, Allgemeinchirurgie, Salzburg
  • Jan Schirnhofer - Krankenhaus der Barmherzigen Brüder, Allgemeinchirurgie, Salzburg
  • Christof Mittermair - Krankenhaus der Barmherzigen Brüder, Allgemeinchirurgie, Salzburg
  • Christian Obrist - Krankenhaus der Barmherzigen Brüder, Allgemeinchirurgie, Salzburg
  • Matthias Biebl - Krankenhaus der Barmherzigen Brüder, Allgemeinchirurgie, Salzburg
  • Walter Brunner - Krankenhaus der Barmherzigen Brüder, Allgemeinchirurgie, Salzburg
  • Robert Frass - Krankenhaus der Barmherzigen Brüder, Allgemeinchirurgie, Salzburg
  • Nicolas Waldstein - Krankenhaus der Barmherzigen Brüder, Allgemeinchirurgie, Salzburg
  • Helmut Weiss - Krankenhaus der Barmherzigen Brüder, Allgemeinchirurgie, Salzburg

Deutsche Gesellschaft für Chirurgie. 129. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 24.-27.04.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12dgch125

doi: 10.3205/12dgch125, urn:nbn:de:0183-12dgch1259

Published: April 23, 2012

© 2012 Pimpl et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Introduction: Preoperative diagnosis of tumors of the mid and upper abdomen can usually be established with high accuracy by means of radiology studies in conjunction with serum tests. However, large intraperitoneal masses may be difficult to accurately assign to a specific organ

Materials and methods: We report on a 41 year-old male patient suffering from a large (12x10cm) right upper quadrant tumor. Preoperative CAT-scan suggested an exophytic tumor of the right hemiliver in a non-cirrhotic patient. However, preoperative serum tumor markers and liver function tests were normal. Due to the inconclusive constellation, a diagnostic laparoscopic procedure was scheduled.

Results: Single port preparation of the tumor could be completed without adding any additional trocar. The strong vascularized tumor did not arise from the liver, but infiltrated the right kidney and showed a small area of ingrowth into the duodenal serosa. Assuming a sarcoma of the right kidney, an open en-bloc resection with oncological nephrectomy was performed. On postoperative day seven, severe duodenal bleeding required an emergency relaparotomy and a full-thickness resection of the former contact area of the duodenal wall was performed. The further postoperative course was uneventful.

Histology surprisingly revealed a malignant gastrointestinal stroma tumor arising from the duodenal wall. Imatinib therapy was started and led to livethreatening angioneurotic edema with multiple intestinal fistulas. Thorough local treatment allowed recovery within 6 months.

Conclusion: Gastrointestinal stroma tumors may also occur as primary tumors of the omentum, mesentery or retroperitoneum.