Laparoscopic Resection of a Large Jejunal Diverticulum-Like Gastrointestinal Stromal Tumor: A Case Report.

introductionGastrointestinal stromal tumors (GISTs) that present as large jejunal diverticulum-like lesions are exceedingly rare, with only 8 cases reported in the English literature to date. Notably, all previously documented cases were treated via open surgery. To our knowledge, this is the first report of successful laparoscopic resection of such a lesion. This case contributes novel insight into the management of rare GIST presentations and demonstrates the potential applicability of minimally invasive surgery. CASE PRESENTATION: A man in his 70s was incidentally diagnosed with a large jejunal diverticulum-like structure on abdominal CT. The lesion eventually perforated during follow-up, requiring emergency laparoscopic partial jejunal resection. Due to severe inflammation and infiltration around the lesion, partial colectomy was also required. Intracorporeal anastomoses were performed for both the jejuno-jejunal and colo-colic reconstructions. Histopathological analysis confirmed the diagnosis of GIST, revealing a 10.2-cm mass that had completely replaced the original jejunal wall structure. The tumor was thought to have arisen from the jejunal muscularis propria and expanded outward, creating a pseudo-diverticular appearance. Postoperative recovery was uneventful; however, multiple liver metastases developed shortly thereafter. The patient was started on imatinib therapy, resulting in a sustained reduction in tumor size.

conclusionsThis case demonstrates that laparoscopic resection is feasible even for rare and complicated presentations of jejunal GISTs, such as those mimicking large jejunal diverticula. It provides new evidence supporting the safety and effectiveness of minimally invasive surgery in emergency settings involving tumor perforation.