Perforated Jejunal Gastrointestinal Stromal Tumor in a Young Male Patient With Acute Peritonitis: A Case Report and Literature Review

TL;DR

A young man with a rare perforated tumor in his intestine was successfully treated with surgery and medication, highlighting the need for early diagnosis and follow-up.

Contribution

This case report presents a rare instance of a perforated jejunal GIST in a young patient and emphasizes the importance of prompt surgical and multidisciplinary management.

Findings

A 32-year-old male was diagnosed with a perforated jejunal GIST confirmed via CT and histopathology.

The patient underwent successful surgical resection and adjuvant imatinib therapy with no residual disease on follow-up PET-CT.

Perforated jejunal GISTs are rare, aggressive, and require prompt surgical intervention and long-term surveillance.

Abstract

Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms of the gastrointestinal (GI) tract, typically diagnosed in older adults. Jejunal GISTs with spontaneous perforation leading to acute peritonitis are uncommon, particularly in young individuals. We report the case of a 32-year-old male who presented with acute abdominal pain, vomiting, and peritoneal signs. Contrast-enhanced computed tomography (CT) revealed pneumoperitoneum and a heterogeneously enhancing mass at the jejunoileal junction, raising suspicion for a perforated GIST. Emergency exploratory laparotomy confirmed a 6 × 6 cm perforated tumor on the antimesenteric border of the jejunum, which was resected with primary anastomosis. Histopathology confirmed a high-grade spindle-cell GIST with increased mitotic activity. The patient recovered well postoperatively and started on adjuvant imatinib therapy following oncological consultation. A four-week post-discharge positron emission tomography-CT (PET-CT) scan showed no residual disease or metastasis. Perforated jejunal GISTs are rare and carry a high risk of recurrence and poor prognosis if not promptly managed. Surgical resection remains the cornerstone of treatment, with adjuvant tyrosine kinase inhibitor therapy recommended for high-risk cases. Given the aggressive nature of perforated GISTs, long-term surveillance is essential. This case highlights the importance of early diagnosis and prompt surgical intervention in perforated jejunal GISTs, particularly in younger patients. Multidisciplinary management with adjuvant therapy and rigorous follow-up is crucial to optimizing outcomes.

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