Spontaneous Hemoperitoneum Caused by Malignant Gastrointestinal Stromal Tumor: A Case Report

TL;DR

A rare case of a ruptured stomach tumor causing internal bleeding is described, highlighting the importance of emergency surgery and drug treatment.

Contribution

This case report adds to the limited literature on spontaneous hemoperitoneum caused by ruptured gastrointestinal stromal tumors.

Findings

A 67-year-old female presented with ruptured gastric GIST causing hemoperitoneum.

Emergency surgery with wedge resection was performed, followed by imatinib therapy due to tumor rupture and positive margins.

Abstract

Gastrointestinal stromal tumors (GIST) are less prevalent mesenchymal tumors, accounting for 1% of gastrointestinal malignancies. Spontaneous hemoperitoneum (SH) following gastric GIST rupture is a rare occurrence. The present study described a case of a 67-year-old female who presented with acute onset abdominal pain. Vital signs at the time of presentation were unstable. Contrast-enhanced computed tomography (CECT) of the abdomen revealed a mixed-density mass lesion with multiple hyperdense areas within. A hemogram indicated a low hemoglobin level. An emergency laparotomy revealed a ruptured pedunculated, friable mass with active bleeding arising from the lesser curvature of the stomach. A wedge resection was carried out to achieve a gross negative margin of the mass. Final pathology confirmed GIST epitheloid type with positive margins (pT3N0M0-pathologically tumor size within 10 cm with no nodal or distant metastasis) and positive for CD117, DOG1.

Given the tumor rupture and positive margins, the patient was started on imatinib mesylate therapy. As demonstrated in this case, GIST rarely ruptures, resulting in hemoperitoneum. The primary treatment approach is surgical exploration and resection.

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