ArticleAnnals of medicine and surgery (2012)2026
Small bowel volvulus revealing advanced jejunal gastrointestinal stromal tumor with diffuse metastases: a case report.
Article in Annals of medicine and surgery (2012), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, with 25-30% arising from the small intestine. While GISTs commonly present with abdominal pain or gastrointestinal bleeding, they may rarely manifest as acute surgical emergencies such as small bowel volvulus (SBV). Presentation with diffuse metastatic disease, including umbilical involvement (Sister Mary Joseph's nodule), at initial diagnosis is exceptionally uncommon. Case presentation: A 60-year-old woman presented with acute abdominal pain, vomiting, and obstipation for 2 days. Clinical examination revealed a soft, non-tender, distended abdomen with preserved bowel sounds. Imaging revealed small bowel obstruction with the characteristic whirlpool sign, a pelvic mass, diffuse peritoneal deposits, a Sister Mary Joseph's nodule, and a hepatic lesion. Emergency laparotomy revealed a 13.0 × 7.5 × 6.5 cm jejunal mesenteric mass causing a 180° anticlockwise volvulus with widespread peritoneal, omental, and umbilical nodules. Segmental jejunal resection with jejunojejunal anastomosis was performed for symptom palliation. Histopathology confirmed spindle-cell GIST, positive for CD117 and DOG1, with a mitotic count of 1/5 mm Clinical discussion: SBV secondary to GIST is rare and typically occurs in the presence of large extramural tumors that act as a lead point for mesenteric rotation. This case highlights the insidious biological behavior of GISTs, wherein prolonged asymptomatic growth may culminate in advanced metastatic disease at presentation, despite low proliferative indices. The presence of Sister Mary Joseph's nodule further signifies advanced intra-abdominal dissemination and poor prognostic implications. Conclusion: GISTs should be considered in cases of unexplained SBV. This case emphasizes the diagnostic challenges, the need for prompt surgical palliation, and the role of systemic tyrosine kinase inhibitors in advanced presentation of GIST.
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