SMALL INTESTINE INTUSSUSCEPTION DUE TO GASTROINTESTINAL STROMAL TUMOR IN PREGNANCY: A CASE REPORT
Keywords:GIST, pregnancy, nonspecific symptoms, multidisciplinary
Gastrointestinal stromal tumour (GIST) is very rare in pregnancy and only a few cases have been described in the literature. We present a case of a 38-year-old primigravida, presented with non-specific symptoms for the first time in the second trimester. Due to the non-specificity of the symptoms on one hand and the rarity of the tumour on the other, it took a long time for the final diagnosis to be made.
Accidentally, on a routine obstetric ultrasound examination, a solid tumour formation was observed, localized under the lower pole of the left kidney. On MRI of the abdomen, in front of the left kidney there was a tubular structure, in close relation with small intestine, suspected for intussusception. At 28 weeks of gestation, an exploratory laparotomy was performed with resection of the involved part of the jejunum and TT anastomosis. Pregnancy was terminated electively, by caesarean section, in 38+6 gestational weeks.
The clinical presentation of the GIST depends on the primary location of the tumour. Due to the extremely rare occurrence of these tumours in pregnancy, there is no solid scientific evidence for the most appropriate time of their treatment and the time of termination of pregnancy. The biggest challenge in pregnancy is timely diagnosis and treatment, without impact on the foetus. A multidisciplinary approach is needed. In our case, the severity of the mother’s symptoms outweighed the danger to the foetus from general anaesthesia and surgery itself.
Weishaupt J, Herbst U. Steroid cell tumour in pregnancy: Reflection on a rare case and review of the literature. Case Rep Obstet Gynecol 2020; 2020: 1817042. doi: 10.1155/2020/1817042.
Morgan J, Raut CP, Duensing A, Keedy VL. Clinical presentation, diagnosis, and prognosis of gastrointestinal stromal tumours. [Internet] UpToDate. 2022. Available from: https://www.uptodate.com/contents/clinical-presentation-diagnosis-and-prognosis -of-gastrointestinal-stromal-tumors
Tanaka N, Tamada S, Ueno N, Ishida M, Kodama J, Kunota T. A rare maternal gastrointestinal stromal tumor found in the second trimester of pregnancy: A case report. Case Rep Womens Health 2020; 28: e00251. doi: 10.1016/j.crwh.2020.
Sandrasegaran K, Rajesh A, Rydberg J, Rushing DA, Akisik FM, Henley JD, et al. Gastrointestinal stromal tumors: clinical, radiologic, and pathologic features. AJR Am J Roentgenol 2005; 184: 803-811, doi: 10.2214/ajr.184.3.01840803.
Blackstein ME, Blay JY, Corless C, Driman DK, Ridell R, Soulieres D et al. Gastrointestinal stromal tumours: consensus statement on diagnosis and treatment. Can J Gastroenterol 2006; 20: 157-163. doi: 10.1155/2006/434761.
Chariff I, Khalil N, Ousadden A, Benjelloun EB, Mesbahi O, Mellouki I, et al. Pregnancy with Gastric stromal tumor. Case Reports in Clinical Medicine 2014; 3: 571-576. doi: 10.4236/crcm.2014.311124.
Chaudhry UI, DeMatteo RP. Advances in the surgical management of gastrointestinal stromal tumor (GIST). Adv Surg 2011; 45: 197-209. doi: 10.1016/j.yasu.2011.03.018.