Large Jejunal Gastrointestinal
Stromal Tumor Presenting as
Intestinal Obstruction
A CASE REPORT
Dr. Nayef Al Abedallat
Head of Surgery Department
Zarqa New Governmental Hospital
Introduction
GISTs are the MC mesenchymal neoplasms of the GI tract .
Although they account for less than 1% of all GI tumors.
The incidence of GIST tumors is 1–2/10^5 population
GISTs arise usually from the muscularis mucosa or propria layers
GIST arises most commonly from:
 The stomach (60–70%), followed by small bowel (20–25%).
 Of which jejunal GISTs are the rarest subtype.
They usually present with non-specific symptoms:
 Abdominal pain, epigastric mass and GI bleeding .
Tumors larger than 4 cm may present as abdominal emergencies:
 Including GI hemorrhage, intestinal obstruction, or perforation.
Conclusion
This case was reported due to the rare incidence of jejunal GISTs
To highlight the challenges in diagnosing jejunal GISTs .
To stress the fact that although obstruction from GIST tumors of
the small bowel is a rare occurrence, but still it might happen.
To raise awareness of GISTs and to raise the level of suspicion
required for the diagnosis of such a rare entity.
Better understanding of the cell of origin and
immunohistochemical markers has made targeted therapy
possible in GIST.
 GISTs treatment has been revolutionized with the introduction
of imatinib.
The 47th Conference of JSS & the 7th Conference of
Surgical Specialty / MOH
Dr. Omar Suleiman
Resident General Surgery
Case Report
A 65-year-old male with medical history of hypertension and diabetes
mellitus, previously surgically free.
Presented to the ED with diffuse abdominal pain and distention.
 Nausea, vomiting and constipation for 5 days.
On PE:
 Vital signs were normal and stable, patient was afebrile.
 Abdominal distention, generalized tenderness and a palpable epigastric
mass.
 Absent bowel sounds and an empty rectum.
 CBC, Urine analysis, Serum Chemistry were requested
 all normal except for low Hb.
 An abdominal X-ray revealed small bowel obstruction pattern.
 Ultrasonography examination revealed mass lesion with solid and cystic
areas in the mesentery attached to small intestine suggestive of mesenteric
mass (? mesenteric cyst).
 A CT scan of the abdomen and pelvis was requested
 Identified a large 10*15 CM mass obstructing the small bowel with solid
and cystic components, with no evidence of distant metastasis.
 The patient previously complained of vague epigastric abdominal pain for 3
years, and extensive investigations including blood tests, OGD, colonoscopy
and even a CT scan were requested, and all investigations were normal on
multiple occasions.
 Emergency laparotomy was performed with excision of the mass along with
small bowel resection and primary end to end anastomosis
 On histopathological reports, the lesion was composed of areas of spindle
and epithelioid cells, and immunohistochemical analysis showed positive
staining with CD117 consistent with GIST
 The postoperative period was uneventful, and the patient was discharged
after 7 days and commenced on imatinib for 3 years.