Huge Gastrointestinal Stromal Tumor of the Jejunum Presenting as Bowel Obstruction: A Rare Presentation

Abstract

Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors of the gastrointestinal tract arising from interstitial Cajal cells. A 54-year-old male patient without any comorbidities presented to the emergency department with complaints of abdominal distension, inability to pass flatus, and no motion for the past 2 days. Abdominal X-ray showed multiple air-fluid levels suggesting bowel obstruction. The patient was managed conservatively at first. Later, ultrasonography and contrast-enhanced computed tomography (CECT) of the abdomen were done, which revealed a mass lesion arising from the jejunum suggestive of GIST. The patient was taken up for exploratory laparotomy, and a tumor was found in the proximal jejunum around 10 cm from the duodenojejunal junction and encompassing the hepatic flexure of the transverse colon, with the omentum found adhered to the anterior surface of the lesion and distended proximal bowel loops. There was no evidence of mesenteric lymphadenopathy. The mass was resected along with the jejunal loop and the hepatic flexure of the colon, followed by end-to-end jejunojejunal anastomosis and end-to-end colocolic anastomosis. The patient’s postoperative stay was uneventful. Imatinib therapy was started following histopathological confirmation and continued. The patient was followed up for 1 year postoperatively with CECT of the abdomen every 6 months, with no evidence of recurrence or any gastrointestinal symptoms.