Removal of giant gastrointestinal stromal tumor (GIST)
Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal neoplasms of the gastrointestinal tract accounting for approximately 1-3% of all gastrointestinal tumors.
The incidence rate for GIST is calculated 10-20 cases per million inhabitants, which is about 5000 of cases annually. This makes GIST the most common sarcoma among more than 70 malignant tumors arising in connective tissues.
Clinical manifestation of GISTs can be manifested with symptoms of gastrointestinal bleeding, difficulty swallowing, metastases (mainly in the liver).
Intestinal obstruction is rare in connection with typical tumor growth outward. By the time of diagnosis, the tumor can reach quite large sizes. Verification of the diagnosis is done during a biopsy procedure, which can be performed endoscopically percutaneously (under CT or US control), as well as during surgical intervention.
Patient O.A. 1961y/b, in 08.01.2018. was admitted to General & Thoracic Surgery Department of MC Erebouni with complaints of abdominal swelling in recent months, frequent nausea, vomiting, red stool with visible blood, weakness, loss of appetite. Anamnesis: surgery for appendicular peritonitis.
All necessary laboratory and instrumental examinations were carried out (abdominal sonography, CT angiography). Clinical findings: a giant acinar tumor with a diameter of up to 60-70 cm, starting from the first loop of the jejunum with luminal compression and extravasation of contrast into the lumen of the GI tract, liquid in the small pelvis).
In 09.01.2018г on an urgent basis a team of surgeons including Dr. A.B. Aleksanyan, Dr. G.S. Grigoryan, anesthesiologist A.M. Oganesyan, under the supervision of A.C. Vardanyan, PhD a surgical intervention was carried out: total median laparotomy, separation of adhesions, complete excision of the tumor with high jejunal resection and end-to-end anastomosis, sanitation and drainage of the abdominal cavity. The surgery was performed using the new LigaSure technologies.
Similar severe pathologies are rare. The specialists consider the prognosis for surgical treatment of stromal gastric tumors usually more favorable than in other localizations. The postoperative period went without complications. The patient was discharged on the 9th day under the supervision of an oncologist. After 1-2 months, a repeated CT angiography hasn`t revealed recurrence of disease.