A case of ruptured gastrointestinal stromal tumor in the stomach with intraabdominal hemorrhagic shock

腫瘍破裂で出血性ショック状態となった胃GISTの1手術例

A case of ruptured gastrointestinal stromal tumor in the stomach with intraabdominal hemorrhagic shock

Creators Hirata Ken

Creators Yano Yuka

Creators Inokuchi Toshihiro

Creators Kuga Takayuki

Creators Fujii Yasuhiro

Creators Nishimura Junichi

Creators Yamaguchi Yuki

Creators Mitani Nobuyuki

Creators Nagadomi Yuji

胃のgastrointestinal stromal tumor(GIST)腫瘍破裂により出血性ショックを来した1例を経験したので報告する.症例は67歳の男性.精神科病院に入院中であった.約10日前から食欲低下,低血圧を認めていたが,ショック状態を来し当院に緊急紹介された.受診時Hb4.8g/dlと高度貧血を認めた.CTで胃体部大弯から後壁に10cm大の腫瘍性病変,腫瘍内出血と血性腹水を認めた.胃粘膜下腫瘍の腫瘍破裂と診断し緊急手術が施行された.約1400mlの血性腹水と,胃体上部後壁から壁外性に発育した手拳大の腫瘍を認めた.膵尾部と脾臓への癒着あり,胃全摘術+膵尾部脾合併切除術が行われた.病理組織学的検査で胃GISTと診断された.胃GIST腫瘍破裂例は比較的少ないが,再発の高リスク群である.イマチニブ療法を開始し,術後27日目に前医へ転院した.術後14ヵ月現在,再発なく外来通院中である.

We report herein the case of a 67-year-old man in whom a hemorrhagic shock was caused by a ruptured gastrointestinal stromal tumor(GIST)of the stomach. He had admitted to a psychiatric hospital because of mental retardation, deafness, and dumbness. Anemia and low blood pressure developed and he was admitted to our hospital. Abdominal computed tomogram and esophago-gastric-duodenal scopy demonstrated hemorrhagic ascites and ruptured gastric submucosal tumor. Thus, an emergency laparotomy was performed. The total gastrectomy with resection of pancreatic tail and spleen was performed. Microscopic findings revealed a ruptured gastric GIST. Operation and chemotherapy with Imatinib led to a cure for the patient. We should pay attention to follow up the patient.

[ISSN]0513-1731

[NCID]AN00243156