Back to 2025 Posters
MINIMALLY INVASIVE RESECTION OF GASTROINTESTINAL STROMAL TUMOR (GIST) PRESENTING AS INTUSSUSCEPTION
Nupur Savalia
*, Sevag Hamamah, Faizi Hai
Internal Medicine, Scripps Mercy Hospital San Diego, San Diego, CA
Introduction: Gastrointestinal stromal tumors (GISTs) constitute 1–2% of all gastrointestinal neoplasms but are the most common subtype of soft tissue sarcomas, accounting for 20–25%. In many patients, GISTs are asymptomatic and discovered incidentally. Per review of the literature, when patients with GISTs do present with acute symptoms, the most common clinical presentation is upper gastrointestinal bleeding and gastric discomfort.
Case Description: A 67 year old female with history of chronic iron deficiency anemia, obscure gastrointestinal bleeding, pulmonary embolism (on anticoagulation), rheumatoid arthritis, and polymyalgia rheumatica presented to an outside hospital with 1 day of cough, shortness of breath and chest tightness. She also reported a one month history of intermittent abdominal pain. Computed tomography (CT) angiography of the chest with and without contrast showed right sided pneumonia but also incidentally showed a small bowel obstruction with transition in the mid small bowel related to a focal intussusception with a possible small bowel mass.
In reviewing her history, two years prior, the patient had extensive evaluation for iron deficiency anemia and intermittent melena with an unremarkable upper endoscopy and colonoscopy. Capsule endoscopy showed a 20mm polypoid lesion midway through the small bowel. An antegrade and retrograde single balloon endoscopy did not find any lesions. An antegrade double balloon endoscopy did not find any lesions. An MR enterography did not identify any small bowel lesion.
A CT enterography was performed during this hospitalization which showed distal small bowel obstruction consistent with intussusception with a 3 cm small bowel mass as the lead point. General surgery was consulted and the patient underwent a robot assisted surgery. Reduction of intussusception was attempted intraoperatively but unsuccessful and the area of small bowel was subsequently resected. Pathology of the mass revealed that it was a low grade/T2 GIST with spindle cells (mitotic rate 1).
Discussion: Our case illustrates the difficulty with diagnosis of GIST, especially in the small bowel, since patients do not generally present with acute or specific symptoms and most cases are incidentally found. Given that size greater than 5 cm and high mitotic rate is associated with a poor prognosis, misdiagnosis or delayed diagnosis can negatively impact a patient's chance of survival. This case highlights the fact that multiple modalities may be needed to diagnose a GIST which is crucial in improving outcomes for patients. Complete surgical resection remains the mainstay of treatment for GIST and this case also demonstrates the feasibility of a minimally invasive surgical approach.
Back to 2025 Posters
