A rare scenario of perforated gastrointestinal stromal tumours of ileum

Mrinal Shankar, K. Ravindra, Manju R., Radhakrishna Ramchandani


Gastro-intestinal stromal tumours (GIST) are among the common mesenchymal tumours of the gastro-intestinal (GI) tract. It varies in location and presentation. GIST are reported in the stomach frequently (60-70%), followed by small intestine (20-25%). Mainly GIST manifest typically with bleeding or vague abdominal pain and discomfort. The spontaneous perforation of GIST is very rare. We report case of a middle-age male patient who presented in emergency with pain in right lower abdomen associated with features of peritonism. After clinical evaluation and preliminary radiological investigations, a working diagnosis of perforated appendix was made. Patient was undertaken for emergency surgery. A diagnostic laparoscopy followed by midline laparotomy was done. Intra-operatively, a perforated and necrotic outpouching at antimesenteric border of terminal ileum was found. Histopathological examination of the resected part of ileum revealed compatibility with GIST. It was strongly positive for cluster of differentiation 117 (CD117) and smooth muscle actin. Patient received adjuvant therapy with Imatinib. A complete surgical resection without extensive lymph node sampling is the primary treatment option. As GIST are rare, a high index of suspicion is warranted for diagnosis and appropriate treatment.


Gastro-intestinal stromal tumours, Perforation, Terminal ileum, Imatinib

Full Text:



Joensuu H, Eriksson M, Hall KS, Hartmann, Pink D, Schütte J, et al. One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: a randomized trial. JAMA. 2012;307(12):1265-72.

Menge F, Jakob J, Kasper B, Smakic A, Gaiser T, Hohenberger P. clinical presentation of gastrointestinal stromal tumors. Visceral Med. 2018;34(5):335-40.

Caterino S, Lorenzon L, Petrucciani N, Iannicelli E, Pilozzi E, Romiti A, et al. Gastrointestinal stromal tumors: correlation between symptoms at presentation, tumor location and prognostic factors in 47 consecutive patients. World J Surg Oncol. 2011;9:13.

Sorour MA, Kassem MI, Ghazal Ael H, El-Riwini MT, Abu Nasr A. Gastrointestinal stromal tumors (GIST) related emergencies. Int J Surg. 2014;12:269-80.

Sato K, Tazawa H, Fujisaki S, Fukuhara S, Imaoka K, Hirata Y, et al. Acute diffuse peritonitis due to spontaneous rupture of a primary gastrointestinal stromal tumor of the jejunum: a case report. Int J Surg Case Rep. 2011;39:288-92.

Hosamani IR, Kodaganur S, Chaukimath SM. Perforated gastrointestinal stromal tumor of the Meckel's diverticulum: a case report and review of literature. Ind J Surg. 2016;78(5):390-5.

Tajima T, Nishi T, Tomioku M, Ogimi T, Chan LF, Okazaki T, et al. Perforated gastrointestinal stromal tumor in the small intestine: a rare case of Torricelli-Bernoulli sign. Mol Clin Oncol. 2018;9(4):399-402.