UPPER GASTRO-INTESTINAL BLEEDING IN THE YOUNG - GASTRIC GIST TUMOR OR PEPTIC ULCER DISEASE?

1) Department of Surgery, Harlem Hospital, Columbia University, New York, USA;

2) Department of Surgery, Harlem Hospital, New York, USA;

3) Department of Surgery, Harlem Hospital, Columbia University, New York; Plastic Surgery Fellow, Medical University of South Carolina, Charleston, USA;

4) Department of Surgery, Harlem Hospital, Columbia University, New York; Surgical Critical Care Fellow, Washington University School of Medicine Missouri USA.

Disclosure: The author has declared no conflicts of interest.

Received: 09.09.15 Accepted: 17.09.15

  doi: 10.5455/ijsm.20150917100638

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Abstract:

GIST tumors is very unusual in the young and middle aged and a high index of suspicion is needed for the diagnosis in young patients who present with upper gastrointestinal bleeding. Appropriate imaging such as a Computed tomographic scan (CT scan) may identify this tumor which may easily be misdiagnosed as a bleeding Peptic Ulcer Disease in the young.
We present a case of a healthy 38 year old man with no alcohol use who presented with epigastric pain and melena and subsequent torrential bleeding uncontrolled during endoscopy necessitating an emergency exploratory laparotomy by the general surgery team. The bleeding intraluminal component of the tumor with gross splenic and pancreatic involvement was identified and surgical management consisted of a wedge resection of the greater curvature of the stomach incorporating the tumor and the spleen with successful dissection of the tumor off the tail of the pancreas. Histology was positive for C-KIT and DOG-1 markers. Postoperative course was uneventful and he is presently on Imatinib Mesylate.

Keywords: Gastrointestinal stromal tumor; endoscopy; C-KIT, DOG-1Neuroblastoma, Adult, retroperitoneal mass

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