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Category: Volume 06 Issue 06 June 2018
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Title: Emergency Presentation and Management of Gastrointestinal Stromal Tumour: Our Experience

Authors: Priya Ranjan, Vijay Chetan Jha, Sita Ram Ghosh

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i6.43

Abstract

Background: GIST are the most common mesenchymal tumours of the GI tract and in GI tract it arises most commonly from stomach followed by small intestine. Mostly GIST is asymptomatic and their presentation depends upon their site and size. Symptomatic patients present with anaemia, GI bleeding, abdominal pain and obstruction. Complete resection is standard and curative.  Tyrosine kinase receptors are useful in management of high risk GISTs, advanced, recurrent and metastatic tumours.

Aim: The aim of this study is to analyse the clinical data of GIST patients who presented with acute symptoms.

Material and Methods: The clinical data of GIST patient who presented between Jan 2013 to Mar 2018 along with their clinical presentations, radiological and endoscopic data, surgical procedures, follow up data were collected and analysed.

Results: 23 patients (13 males and 10 females) presented with acute symptoms who were diagnosed to have GIST. The GIST was located in stomach in 10 patients, in small intestine in 10 patients, in colon in 1 patients and in rectum in 2 patients. Pain abdomen and GI bleeding were the most common symptoms followed by intestinal obstruction.  All 23 patients underwent surgical exploration. Complete macroscopic resection was achieved in 21 patients, while 2 patients had palliative and incomplete resection.  Two patients with small intestine GIST developed recurrence/ metastases.  One patient had mortality on 2 years follow-up.

Conclusion: GISTs are uncommon tumours and few of GISTs presents with acute symptoms. The patients with chronic anaemia and recurrent abdominal pain need evaluation and work up for GIST. Surgery remains the gold standard treatment in localized GIST. Large GISTs may require Neo-adjuvant chemotherapy to increase resectability of tumour. Anatomical site of primary tumour, size of tumour, completeness of surgical resection, tumour pseudo capsule rupture and response to chemotherapy affects the prognosis and recurrence. Early resuscitation, diagnosis and surgical treatment affects the outcome in GIST related emergencies.

Keywords: Gastrointestinal Stromal Tumours, Imatinib, Tyrosine Kinase Inhibitors, Intussusception

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Corresponding Author

Vijay Chetan Jha

MBBS, MS, MCh (GI Surgery), Command Hospital (EC), Kolkata 700027

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