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Perforated Gastrointestinal Stromal Tumor of the Meckel’s Diverticulum: a Case Report and Review of Literature

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Abstract

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the GI tract, they have a wide spectrum of clinical manifestations, and a small proportion of them present as an acute abdomen due to obstruction, perforation, or hemoperitoneum. We present a case of a perforated GIST of the Meckel’s diverticulum and review the current literature on perforated GISTs. We ran a search on Pubmed and Google Scholar with the following terms “perforated GIST,” “perforated Meckel’s diverticulum,” “GIST with peritonitis,” and “GIST in Meckel’s diverticulum.” After selecting the relevant articles, we tabulated our results and analyzed the data. Out of the 45 cases, 32 (71.1 %) were male and 13 (28.8 %) were female. Out of the 45 reported cases, 41 (91.1 %) were from the small intestine, 2 (4.44 %) cases from the stomach, and 2 (4.44 %) from the small bowel. In 15 (33.33 %) cases, the site of perforation was the Meckel’s diverticulum (MD). Forty-year-old male, presented with features of peritonitis localized to the right iliac fossa, was diagnosed as acute appendicitis and subjected to a diagnostic laparoscopy. Intraoperatively, a perforated Meckel’s diverticulum was found, which on histopathological examination contained a low-grade GIST. Our literature search revealed that in reported cases of perforated GISTs, there is a slight male preponderance. Small bowel appears to be the most common site for a perforated GIST, and a significant proportion (30.23 %) arise from the Meckel’s diverticulum. And most importantly, the commonest tumor to cause perforation of a Meckel’s diverticulum is a GIST.

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References

  1. Alessiani M, Gianola M, Rossi S, et al. (2015) Peritonitis secondary to spontaneous perforation of a primary gastrointestinal stromal tumour of the small intestine: a case report and a literature review. Int J Surg Case Rep 6:58–62

    Article  Google Scholar 

  2. Miettinen M, Lasota J (2013) Gastrointestinal stromal tumors. Gastroenterol Clin N Am 42(2):399–415

    Article  Google Scholar 

  3. Chen HW, Lin TY (2012) Tumor abscess formation caused by Morganella morganii complicated with bacteremia in a patient with gastrointestinal stromal tumor. Clin Res Hepatol Gastroenterol 36(2):e29–e31

    Article  PubMed  Google Scholar 

  4. Lorusso R, Forte A, Urbano V, Soda G, D’Urso A, Bosco MR, Mancini P, Bezzi M (2003) Small bowel stromal tumors ina “meckelian” location: about a clinical observation. Ann Ital Chir 74:707–711

    CAS  PubMed  Google Scholar 

  5. Sagar J, Kumar V, Shah DK (2006) Meckel’s diverticulum: a systematic review. J R Soc Med 99:501–505

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cotirlet A, Anghel R, Tincu E, Rau S, Motoc I, Popa E (2013) Perforation of Meckel’s diverticulum by foreign body, a rare complication. Chirurgia (Bucur) 108(3):411–413

    CAS  Google Scholar 

  7. Hortezky K (1956) Perforated peptic ulcer in Meckel’s diverticulum. Wien Klin Wochenschr 68(4):66–67 German

    Google Scholar 

  8. Nordsten M, Brynitz S (1986) Carcinoid of Meckel’s diverticulum. Report of two cases with perforation, in one with concomitant foreign body. Acta Chir Scand 152:551–553

    CAS  PubMed  Google Scholar 

  9. Nishibe M, Nishibe T, Yamashita T, Kaji M, Fukuhara I, Yasuda K (2001) Perforated leiomyosarcoma of Meckel’s diverticulum: report of a case. Surg Today 31(2):163–165

    Article  CAS  PubMed  Google Scholar 

  10. Sheth M, Rosenberg V, Kim U (1978) Perforated leiomyosarcoma of Meckel’s diverticulum: a case report and review of literature. Mt Sinai J Med 45(3):322–328

    CAS  PubMed  Google Scholar 

  11. Yamamoto S, Kubo S, Shuto T (2003) Treatment with STI571, a tyrosine kinase inhibitor, for gastrointestinal stromal tumor with peritoneal dissemination and multiple liver metastases. J Gastroenterol 38:896–899

    Article  CAS  PubMed  Google Scholar 

  12. Szentpáli K, Palotás A, Wolfárd A, et al. (2004) A gastrointestinal stromal tumour presenting in a perforated Meckel’s diverticulum. Can J Surg 47:70

    PubMed  PubMed Central  Google Scholar 

  13. Efremidou EI, Liratzopoulos N, Papageorgiou MS, Romanidis K, Manolas KJ, Minopoulos GJ (2006) Perforated G.I.S.T. of the small intestine as a rare cause of acute abdomen: surgical treatment and adjuvant therapy. Case report. J Gastrointestin Liver Dis 15:297–299

    PubMed  Google Scholar 

  14. Karagülle E, Türk E, Yildirim E, Göktürk HS, Kiyici H, Moray G (2008) Multifocal intestinal stromal tumors with jejunal perforation and intra-abdominal abscess: report of a case. Turk J Gastroenterol 19:264–267

    PubMed  Google Scholar 

  15. Hur H, Park AR, Jee SB, et al. (2008) Perforation of the colon by invading recurrent gastrointestinal stromal tumors during sunitinib treatment. World J Gastroenterol 14:6,096–6,099

    Article  Google Scholar 

  16. Versaci A, Macri A, Grosso M (2009) Acute abdomen for perforated gastrointestinal stromal tumor (GIST). A case report. Ann Ital Chir 80:69–73

    PubMed  Google Scholar 

  17. Taniguchi M, Fukuda M, Kobayashi H, Kawata A (2009) A case of gastrointestinal stromal tumor (GIST) of the small intestine presenting with perforative peritonitis. J Abdom Emerg Med 29:931–935

    Google Scholar 

  18. Licursi M, Bonsignore A, Fiumara F (2009) Gastrointestinal stromal tumors (GISTs): personal experience on three cases of the tumors of the small intestine complicated and emergency surgically treated. G Chir 30:276–285

    CAS  PubMed  Google Scholar 

  19. MC K, Tsai CM, Tyan YS (2010) Multiple gastrointestinal stromal tumors in a patient with type I neurofibromatosis presenting with tumor rupture and peritonitis. Clin Imaging 34:57–59

    Article  Google Scholar 

  20. Özben V, Çarkman S, Atasoy D, Doğusoy G, Eyüboğlu E (2010) A case of gastrointestinal stromal tumor presenting with small bowel perforation and internal hernia. Turk J Gastroenterol 21:470–471

    Article  PubMed  Google Scholar 

  21. Dogrul AB, Kilic YA, Onurdag F, et al. (2010) A gastrointestinal stromal tumor in Meckel diverticulum in an 86-year-old patient. Am J Med Sci 340:156–157

    Article  PubMed  Google Scholar 

  22. Feng F, Chen F, Chen Y, Liu J (2011) A rare perforated gastrointestinal stromal tumor in the jejunum: a case report. Turk J Gastroenterol 22:208–212

    Article  PubMed  Google Scholar 

  23. Paramythiotis D, Panidis S, Papadopoulos V, Panagiotou D, Panteliadou P, Michalopoulos A (2011) Perforated gastrointestinal stromal tumor of the small intestine: a case report presenting with peritonitis. J Curr Surg 1:44–46

    Google Scholar 

  24. Bhandarwar AH, Borisa AD, Kori C, Vora S, Kasat G (2011) Giant jejunal gastrointestinal stromal tumor presenting as acute abdomen. Bombay Hosp J 53:463–467

    Google Scholar 

  25. Aslan F, Alper E, Cantürk F (2012) Gastrointestinal stromal tumor perforation in a case with neurofibromatosis presenting with abdominal pain. Turk J Gastroenterol 23:83–84

    Article  PubMed  Google Scholar 

  26. Memmi N, Cipe G, Bektasoglu H (2012) Perforated gastrointestinal stromal tumor in the jejunum: a rare cause of acute abdomen. Oncol Lett 4:1244–1246

    PubMed  PubMed Central  Google Scholar 

  27. Choudhary G, Koushal G, Bhoriwal S (2012) Jejunal gastrointestinal stromal tumor causing perforation peritonitis in a young male: a case report. Int J Surg 2:8

    Google Scholar 

  28. Sezer A, Sagiroglu T, Ozpuyan F, Erdogan B, Tastekin E (2012) A ruptured gastrointestinal stromal tumor of jejunum causing acute abdomen. J Clin Anal Med 3:341–343

    Google Scholar 

  29. Roy SD, Khan D, De KK, De U (2012) Spontaneous perforation of jejunal gastrointestinal stromal tumor (gist): case report and review of literature. World J Emergency Surg 7:37

    Article  Google Scholar 

  30. Shoji M, Yoshimitsu Y, Maeda T, Sakuma H, Nakai M, Ueda H (2013) Perforated gastrointestinal stromal tumor (GIST) in a true jejunal diverticulum in adulthood: report of a case. Surg Today 20

  31. Beltrán MA, Tapia RA, Cortés VJ (2013) Multiple primary gastrointestinal stromal tumors presenting in jejunum and ileum. Indian J Surg 75(Suppl. 1):S227–S229

    Article  Google Scholar 

  32. Mitura K, Blicharz P, Roman’czuk M (2012) Perforated GIST of Meckel’s diverticulum. Pol Przegl Chir 84:258–261

    PubMed  Google Scholar 

  33. Misawa S, Takeda M, Sakamoto H, Kirii Y, Ota H, Takagi H (2014) Spontaneous rupture of a giant gastrointestinal stromal tumor of the jejunum: a case report and literature review. World J Surg Oncol 12:153

    Article  PubMed  PubMed Central  Google Scholar 

  34. Chou YH, CC T, Huang CC, Hsieh MS (2011) A clinically-occult gastrointestinal stromal tumor in a Meckel’s diverticulum presenting as hollow organ perforation. Chang Gung Med J 34(6 Suppl):56–61

    PubMed  Google Scholar 

  35. Sharma MBK, Barad AK, Padu K, Singh KS, Singh Th SC (2014) Spontaneous perforation as a first presentation of ileal gastrointestinal stromal tumour (GIST) with synchronous breast sarcoma. J Clin Diagn Res 8:–ND7–9

  36. Mansoor E (2014) Multifocal small bowel stromal tumors presenting with peritonitis in a HIV positive patient. Int J Surg Rep 5:243–245

    Article  Google Scholar 

  37. Skipworth JR, Fanshawe AE, West MJ, Al-Bahrani A (2014) Perforation as a rare presentation of gastric gastrointestinal stromal tumors: a case report and review of the literature. Ann R Coll Surg Engl 96:96E–100E

    Article  CAS  PubMed  Google Scholar 

  38. López-Tomassetti Fernández EM, Hernández Hernández JR, Nuñez Jorge V (2013) Perforated gastrointestinal stromal tumor in Meckel’s diverticulum treated laparoscopically. Asian J Endosc Surg 6(2):126–129

    Article  PubMed  Google Scholar 

  39. Woolf R et al. (2009) A gastrointestinal stromal tumour presenting incidentally with haemorrhage and perforation associated with a Meckel’s diverticulum: a case report. J Med Case Rep 3(2):1–5

    Google Scholar 

  40. Hager M et al. (2005) Perforated Meckel’s diverticulum presenting as a gastrointestinal stromal tumor: a case report. J Gastrointest Surg 9(6):809–811

    Article  PubMed  Google Scholar 

  41. Sozen S, Tuna O (2012) A rare case of perforated Meckel’s diverticulum presenting as a gatrointestinal stromal tumor. Arch Iran Med 15(5):325–327

    PubMed  Google Scholar 

  42. Nayak B, Dash RR, Mallik BN (2015) Perforated Meckel’s diverticulum as a result of gastrointestinal stromal tumor presenting as acute abdomen: a rare case report. Oncol Gastroenterol Hepatol Rep 4(1):26

    Article  Google Scholar 

  43. Kiliç MÖ, Şen M, Turkan A, Yildirim Ü, Bozer M, Koketener AA (2015) Rare case of perforated gastrointestinal stromal tumour in a Meckel’s diverticulum. N J Med 32:105–107

    Google Scholar 

  44. Caricato M, Mangiameli G, Miecadei F (2010) A rare case of complicated Meckel’s diverticulum. Case Rep Images 81(6):449–451

    Google Scholar 

  45. Frühauf, Garcia, Rosso (2002) Stromal tumor in a perforated Meckel’s diverticulum: a case report. Swiss Surg 8(6):273–276

    Article  PubMed  Google Scholar 

  46. Goyal R, Chaudhary NK (2013) Gastrointestinal stromal tumour of Meckel’s diverticulum causing perforation and peritonitis: a case report. Indian J Surg 75(1):171–173

    Article  PubMed  Google Scholar 

  47. Sreevathsa MR (2012) Caecal gastrointestinal stromal tumor with perforation and obstruction. Indian J Surg Oncol 3(4):311–313

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Lorenzo MM, Castro LD, Moreiras MIP, Vales JC, Buján JAC (2014) Emergency atypical resection for perforated gastric gist. Open J Gastroenterol 4(03):118

    Article  Google Scholar 

  49. Kivilcim T, Altintoprak F, Onuray F, Beyaz SG, Yildirim M, Dilek ON (2013) Acute abdomen syndrome caused by a perforated gastrointestinal stromal tumor—a case report. J Cancer Res Updat 2(1):10–13

    Google Scholar 

  50. Kim SY, Kim JH, Park DS, Jang GS, Hong EY, An JS, Park CK (2013) A case of perforated gastrointestinal stromal tumor in the jejunum as a rare cause of acute abdomen. Int Res 11(2):134–136

    Google Scholar 

  51. U M, Kumar V, RA R, Kamath S (2014) Perforated GIST in jejunum—a rare cause of abdominal cocoon. J Clin Diagn Res 8(3):132–133

    Google Scholar 

  52. Lesquereux-Martínez L, Macías-García F, Beiras-Sarasquete C, Martínez-Castro JJ, Paulos-Gómez AM, Beiras-Torrado A, Bustamante-Montalvo M (2011) Adenocarcinoma arising in Meckel’s diverticulum: a case report and literature review. Gastroenterol Hepatol 34(3):137–140 (article in spanish)

    Article  PubMed  Google Scholar 

  53. Ikemura M, Kunita A, Miwa Y, Jimbo K, Mori K, Seto Y, Fukayama M (2015) Gut wall replacing type of gastrointestinal stromal tumor presenting as a perforation of the ileal diverticulum. Pathol Res Pract 211(11):892–895

    Article  PubMed  Google Scholar 

  54. Omerza CR, Bouman AK, Bulinski PPA (2016) Rare case of a gastrointestinal stromal tumor (GIST) presenting as a perforated Meckel’s diverticulum. J Gastrointest Cancer

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Authors’ Contribution

IRH and SK were involved in patient care and manuscript preparation, and CSM was the pathologist who reported the slides and provided the microphotographs.

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Authors and Affiliations

  1. Department of General Surgery, Karnataka Institute of Medical Sciences, Hubli, Karnataka, 580022, India

    Ishwar R. Hosamani & Srinivas Kodaganur

  2. Department of Pathology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India

    S. M. Chaukimath

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  1. Ishwar R. Hosamani
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  2. Srinivas Kodaganur
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Correspondence to Srinivas Kodaganur.

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Hosamani, I.R., Kodaganur, S. & Chaukimath, S.M. Perforated Gastrointestinal Stromal Tumor of the Meckel’s Diverticulum: a Case Report and Review of Literature. Indian J Surg 78, 390–395 (2016). https://doi.org/10.1007/s12262-016-1525-7

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