Laparoscopic partial gastrectomy for a giant bleeding GIST of the stomach: A case report

INTRODUCTION: Gastrointestinal stromal tumors (GIST) are rare neoplasms often located in the stomach. Elective laparoscopic surgery is the well-established treatment. Often these tumors have a presentation with acute gastrointestinal bleeding and/or as large masses that challenge mini invasive laparoscopic approach. This article describes the case of a patient with large gastric GIST with bleeding onset and discusses the feasibility and safety of emergency laparoscopy. PRESENTATION OF CASE: A 36-year-old man presented with melena and severe anaemia. An upper endoscopy and abdominal CT scan showed a large gastric fundal submucosal mass of more than 10 cm of diameter close to the superior splenic pole. Because of relapsing bleeding he was submitted to emergency laparoscopy with complete resection of the gastric mass by partial gastrectomy. DISCUSSION: Laparoscopic approach to GIST larger than 10 cm is still a challenging surgical task and the feasibility depends on multiple factors including the location and size of the lesions. Few series of patients have been described in the literature. This case described a giant GIST with major and relapsing gastrointestinal bleeding that induced an emergency surgically approach with a minimally invasive laparoscopic partial gastric resection. CONCLUSIONS: This report described a case of giant gastric GIST that presented with repeated and severe gastrointestinal bleeding and was treated by emergency laparoscopic gastric resection. The feasibility and advantages of the surgical technique are discussed. The best surgical approach in these rare cases has still to be evaluated on individual basis.