Multifocal intestinal stromal tumors with jejunal perforation and intra-abdominal abscess: report of a case

A 70-year-old man with right-sided abdominal pain, inappetence, nausea, and bloating of one-week duration was admitted to our Emergency Department. The abdominal computed tomographic scan showed an abscess (55 x 66 mm) among the intestinal loops. After percutaneous ultrasonography-guided insertion of a drainage catheter into the abscess, pouchography showed that contrast medium had passed into the intestinal lumen via fine tract. The patient underwent surgery because of an intraabdominal abscess caused by intestinal perforation. During laparotomy, a solid mass measuring 5 cm in diameter on the antimesenteric side of the jejunal wall and a perforation of approximately 0.5 cm were identified after exploration of the abscess cavity. In addition, 3 polypoid lesions (2 at the antimesenteric side of the jejunal wall, and 1 at the antimesenteric side of the ileal wall) were found incidentally. Resection and primary anastomosis of the perforated area and wedge resections of the polypoid lesions were performed. The results of pathologic examination of the all-surgical specimens indicated low-grade gastrointestinal stromal tumors. Since there was no metastasis, all the tumors were resected surgically and all were pathologically low-grade tumors, we did not use imatinib, the long-term results of which are not known at present. Neither complications nor evidence of recurrence were seen during the follow- up of 13 months. Stromal tumors of the small intestine are relatively rare and cause subtle clinical signs and symptoms. Their diagnosis is often delayed until complications develop. Even if complications occur, exact diagnosis is usually very difficult preoperatively.