Gastrointestinal stromal tumor leading to acute abdomen and hypovolemic shock in a trauma patient

Gastrointestinal stromal tumors (GISTs) are among the rare tumors of gastrointestinal (GI) tract. GISTs occur respectively in the stomach, small intestines, colon and rectum, omentum and mesentery, esophagus, retroperitoneal space, and abdominal cavity. However, they may occur anywhere along the GI tract. Typically, these tumors generally do not cause symptoms; however symptomatic patients may show stomach pain, GI bleeding, and palpable abdominal masses. These patients usually undergo surgery for obstruction symptoms or some other diagnosis. Our patient was admitted to the emergency department with acute abdomen and hypovolemic shock due to fall. The patient underwent emergency surgery, which revealed active bleeding from a stomach tumor showing an exophytic pattern of growth. This patient was a 32-year-old male, and blood tests revealed a white blood cell count of 23.500/mm³ and a hemoglobin level of 7.9 gr/dL. The heart rate was 110 beats/minute. The chest radiograph showed no subdiaphragmatic free air, and abdominal ultrasound showed impression of a mass that could not be distinguished from the liver, along with closed perforation or hemangioma. During the surgical procedure, 1200 cc of blood was suctioned, and the exophytic tumor was removed completely. Histological analysis of the tumor showed GIST, and it was considered to be a ruptured tumor by the oncology consultant. The patient was applied imatinib for 3 years after the surgery, and the disease did not re-occur during this period. Our goal in this case study is to emphasize that trauma may not be necessarily the cause of acute abdomen for emergency patients but that it also may be caused by hypotension-associated hypovolemic shock or other causes, bleeding from a GIST along with tumor torsion.

Travmalý hastada akut batýn ve hipovolemik þok yapan gastrointestinal stromal tümör

Gastrointestinal stromal tümör (GÝST), gastrointestinal sistemin nadir görülen tümörlerinden biridir. Gastrointestinal sistemin her yerinde olabilir ama en sýk sýrasýyla görüldüðü yerler mide, ince baðýrsaklar, kolorektal, omentum/mezenter, özefagus ve nadiren gastrointestinal sistem ile baðlantýsýz olarak retroperiton veya abdomendir. Genelde semptomsuz seyreder. Semptomlu olursa karýn aðrýsý, gastrointestinal sistem kanamasý, elle muayenede ele gelen kitle gibi bulgular verebilir. Hastalar genellikle obstrüksiyon bulgularý ve baþka tanýlarla ameliyata alýnmaktadýr. Sunacaðýmýz olgu acil kliniðe düþme sonrasý akut karýn ve hipovolemik þok bulgularýyla getirilen, acil þartlarda operasyona alýnan ve operasyonda mideden kaynaklý eksofitik büyümüþ tümör kanamasý olduðu saptanan olgudur. Olgu 32 yaþýnda, erkek hasta ve yapýlan kan incelemelerinde lökosit sayýmý 23.500/mm3, hemoglobin deðeri 7.9 gr/dL, nabýz 110/dk idi. Akciðer grafisinde diafragma altý serbest hava saptanmayan, ultrasonografisinde karaciðerden ayýrt edilemeyen kitlesel görünüm arzeden ve kapalý perforasyon – hemanjiom ayrýmý yapýlamayan hasta ameliyata alýndý. Ameliyatta yaklaþýk 1200 cc kan aspire edildi ve mideden ekzofitik uzaným gösteren kitle total olarak çýkarýldý. Patoloji sonucu GÝST olarak gelen hasta onkoloji bölümü tarafýndan rüptüre kabul edildi. Ameliyat sonrasý üç yýl imatinib tedavisi verildi ve bu süre içinde nüks saptanmadý. Travma sonucu acile baþvuran hastalarda akut karýn nedeninin her zaman travmayla ilgili olmayabileceði, hipovolemik þok veya baþka nedenlerden dolayý tansiyon düþmesi sonucu travmanýn gerçekleþebileceðini vurgulamak ve GÝST’nin kanayýp hipovolemik þoka ve torsiyona uðrayýp akut batýn bulgularýna yol açabileceðini sunmak istedik.