Andy Petroianu*, Weber Chaves Moreira and Maurício Buzelin Nunes
Department of Surgery, School of Medicine, Federal University of Minas Gerais, Santa Casa Hospital of Belo Horizonte, BrazilFulltext PDF
Background: True diverticulum and malignant tumors are rare conditions of jejunum. This is the first published case of a Gastrointestinal Stromal Tumor (GIST) inside a true jejunal diverticulum. Case Report: A59-year-old male presented a sudden abdominal pain with emesis and abdominal distension. Computed tomography of the abdomen revealed a mechanical bowel obstruction caused by a tumor in the small bowel. At laparotomy, an isolated 8.0 cm × 4.5 cm jejunal diverticulum with a perforated tumor was found, about 80 cm from the Treitz ligament. The tumor was removed, as were the segment of the jejunum containing the isolated diverticulum and its correspondent mesentery, including the local lymph nodes. The histologic examination of the tumor revealed a GIST with no lymph node metastasis. After one year, the patient presented a new small bowel obstruction due to six nodules surrounding a jejunoileal segment, far from the first anastomosis. All nodules and a twenty-centimeter-jejunoileal segment were removed. GIST was diagnosed in five nodules. The patient was discharged from the hospital in good conditions on the third postoperative day. During the 38-month-follow-up from the second procedure, no adverse event has been identified. The patient is working, presents no complaints, and is under control with 800 mg imatinib. Conclusion: A GIST may be found inside a jejunal true diverticulum. The treatment must be an en bloc resection of the diverticulum with a segment of jejunum and its mesentery, including all lymphatic tissue. Adjuvant imatinib chemotherapy is indicated to prevent recurrences.
Jejunum; Small bowel diverticulum; Jejunum tumor; Gastrointestinal stromal tumor; Jejunum diverticulum GIST; Intestinal diverticulum GIST
Petroianu A, Chaves Moreira W, Buzelin Nunes M. Gastrointestinal Stromal Tumor Inside a Jejunal True Diverticulum. Clin Surg. 2020; 5: 2749..