A ruptured ileal GI stromal tumor causing hemoperitoneum

 CommentaryGI stromal tumor (GIST) is the most common mesenchymal tumor of the GI tract and is differentiated from other mesenchymal tumors such as leiomyoma by its expression of c-kit protein, also known as CD117. Most GISTs occur in the stomach (60%-70%) and small intestine (20%-30%) and can be asymptomatic or present with abdominal pain, GI bleeding, or a palpable mass. GISTs of the small intestine also rarely can cause hemoperitoneum, in which case the patient usually is older than 60 years of age and the tumor is usually larger than 5 cm in diameter. In general, causes of hemoperitoneum are not obscure. Most are from blunt abdominal trauma involving the liver or spleen, rupture of a blood vessel such as an aortic or splenic aneurysm or a mesenteric varix in a cirrhotic with portal hypertension, ectopic pregnancy, or tumor rupture or leakage, usually with hepatocellular carcinoma or peritoneal metastases. The presentation of this GIST, while rare, was typical in that the patient was elderly, the tumor was large, and when blood is found in the peritoneal cavity either by CT scan or paracentesis, a surgeon's help is usually needed to stanch the bleeding.Lawrence J. Brandt, MDAssociate Editor for Focal Points

PII: S0016-5107(09)02422-5

doi:10.1016/j.gie.2009.08.022

© 2010 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.