Spontaneous Rupture of a Large Exogastric Hemangioma Complicated by Hemoperitoneum and Sepsis
Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. Journal of the Formosan Medical Association
(Impact Factor: 1.97).
01/2007; 105(12):1027-30. DOI: 10.1016/S0929-6646(09)60289-8
Hemangiomas are benign congenital tumors of mature blood vessels and usually consist of dense masses of capillaries or larger blood vessels. Hemangioma of the stomach presenting with spontaneous rupture and sepsis is rare. We report a 22-year-old male who presented at the emergency room with sudden-onset epigastric pain, intractable nausea, and vomiting. Fever, tachycardia, leukocytosis and peritonitis were found on examination after admission. Computed tomography revealed a single, well-defined homogeneous lesion measuring approximately 6 x 8 x 9 cm in size over the left upper abdomen and hemoperitoneum. Laparotomy was performed because of intra-abdominal hemorrhage, peritonitis, and fever. During the operation, a dark red tumor was found on the greater curvature side of the stomach, accompanied by bleeding and hemoperitoneum. The tumor was removed and a wedge resection of the stomach and partial omentectomy were performed. Histopathologic examination of the excised tumor revealed mixed cavernous-capillary hemangioma with central necrosis. The postoperative course was uncomplicated. The pathogenesis of spontaneous rupture and sepsis in this case may have resulted from pedicle torsion accompanied by ischemia, central necrosis, rupture of hemangioma and subsequent peritonitis and sepsis.
Available from: Jonathan A Edlow
- "Ruptured cholangiocarcinomas can rarely present with spontaneous hemorrhage . A mixed cavernous-capillary hemangioma with central necrosis can occur on the greater curvature of the stomach, accompanied by bleeding and hemoperitoneum . Other rare conditions associated with hemoperitoneum include transhepatic rupture of the gall bladder, which has been described fewer than 20 times in the literature . "
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ABSTRACT: Spontaneous hemoperitoneum is rare. The most common etiologies are gynecologic, splenic, and hepatic. Gastrointestinal stromal tumors (GISTs) are commonly associated with intraluminal bleeding, but rarely with spontaneous hemoperitoneum. We report a case of spontaneous hemoperitoneum caused by a gastric GIST.
A 54-year-old male presented with the acute onset of abdominal pain and a drop in hemoglobin. Subsequent evaluation, including a CT, MRI, and EUS, revealed a 1.2-cm mass along the greater curvature of the stomach and associated hemoperitoneum. The patient was taken electively to the operating room for laparoscopic removal of the mass. Pathology confirmed that it was a GIST.
GIST is a rare clinical entity that infrequently presents with spontaneous hemoperitoneum. Emergent treatment should be guided towards treating the spontaneous hemoperitoneum.
International Journal of Emergency Medicine 03/2010; 3(1):53-6. DOI:10.1007/s12245-009-0141-8
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ABSTRACT: Les tumeurs stromales gastro-intestinales (GIST) sont les néoplasies mésenchymateuses les plus fréquentes du tube digestif.
L’atteinte gastrique est la plus courante (60–70 %), suivie de celle de l’intestin grêle (20–30 %). Les GIST possèdent des
caractéristiques immunohistochimiques spécifiques, essentielles au diagnostic. Près de 95%des GIST expriment le c-kit (antigène
CD117), un récepteur transmembranaire tyrosine-kinase dont l’activation déclenche la prolifération cellulaire. La chirurgie
est le traitement de choix des tumeurs résécables, alors que le traitement standard des tumeurs non résécables est l’administration
d’imatinib (Glivec®), un inhibiteur compétitif de c-kit/PDGFRA. Le taux de réponse au traitement par imatinib est d’environ
80 %. Le diagnostic des GIST peut être accidentel ou résulter de l’apparition de symptômes non spécifiques tels que des douleurs
abdominales, une masse abdominale ou un saignement gastro-intestinal. Une rupture dans la cavité péritonéale avec péritonite
représente un événement très rare, et la littérature fait état de très peu de cas de péritonite généralisée comme présentation
clinique initiale de GIST. Nous rapportons, dans cet article, un cas inhabituel de GIST révélé par une péritonite généralisée
provoquée par une rupture spontanée dans la cavité abdominale.
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasia of the gastrointestinal tract. The gastric
presentation is the most frequent (60–70%) followed by the small intestine presentation (20–30%). GISTs have typical immunohistochemical
features which are essential for diagnosis. About 95% of GISTs are positive for c-KIT expression (CD117 antigen), a transmembrane
tyrosine kinase receptor which activation leads to cell proliferation. Surgery is the treatment of choice for resectable tumours,
whereas for unresectable tumours the standard treatment is the administration of imatinib (Glivec®), a c-KIT/PDGFRA competitive
inhibitor. Response rate to imatinib treatment is about 80%. GIST diagnosis might be incidental or due to the appearance of
aspecific symptoms such as abdominal pain, abdominal mass or gastrointestinal bleeding. Rupture in the peritoneal cavity with
peritonitis represents a very rare event and very few cases of generalized peritonitis as initial presentation of GIST, are
reported in the literature.We report here an unusual case of gastric GIST presenting with generalized peritonitis due to spontaneous
rupture in the abdominal cavity.
Mots clésTumeur stromale gastro-intestinale (GIST)-Péritonite-C-kit-Douleur abdominale
KeywordsGastric gist-Peritonitis-C-kit-Abdominal pain
Acta Endoscopica 06/2010; 40(3):195-198. DOI:10.1007/s10190-010-0005-3 · 0.16 Impact Factor
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ABSTRACT: Multiple angiomatosis is a very rare disease formed by histologically benign angiomas spreading beyond single organ or tissue. In the case reported herein, hemangiomas affected several vertebrae of a young man and spread through his peritoneal cavity projecting to his stomach and causing recurrent hematemesis. Also affected was the mediastinum. The patient suffered from bone pain and digestive problems. Initial treatment involved 2 drugs with antiangiogenic effect: interferon alpha (initial dose of6 million units 3 times a week, later reduced to 3 million units 3 times a week due to adverse effects) and zoledronate (4 mg i.v. every 28 days). Even though the therapy eliminated bone pain after 2 months, CT check at a later stage showed but little regression of the mass of the angiomas in the abdominal cavity and the mediastinum. Substantial reduction in the mass of the angiomas to merely residual quantity, i.e. partial remission of the disease, was achieved only after the addition of 100 mg/day thalidomide (Myrin) to the above mentioned doses of interferon and zoledronate administered on a regular basis. However, the disease recurred after the therapy was interrupted, and the above triple combination therapy has had to be restored. Maintenance therapy will succeed to repeated achievement of remission of angiomas. A very good therapeutic effect was recorded for combined interferon alpha, thalidomide and zoledronate in this specific case of multiple angiomatosis.
Vnitr̆ní lékar̆ství 07/2008; 54(6):653-64.
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