Perforated peritonitis due to spontaneous rupture of large gist arising from small bowel– a rare case report

Introduction: Gastro intestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastro intestinal tract. Overt peritonitis caused by GIST rupture is very uncommon. Three types of GIST rupture have been described: closed perforation due to abscess (abscess type), hemoperitoneum leading to rupture of the hematoma capsule in the tumor (hemoperitoneum type), and perforation of the digestive tract via a fistula leading to central necrosis of the tumor (bowel perforation type). This report describes a patient with spontaneous tumor rupture and diffuse peritonitis, a variant of the bowel perforation type of GIST rupture.
Presentation of Case: A 47-year-old female presented with symptoms of abdominal pain, distension & vomiting since 4 days .Computed tomography (CECT) scan revealed- Large enhancing necrotic mesenteric mass in pelvic region measuring 8x7 cm attached to the wall of mid small bowel with focal perforation of the lesion, likely GIST – with perforation. Emergency laparotomy revealed a tumor in the Proximal ileum which was ruptured with a hole measuring 1cm in diameter. The tumor and part of the ileum were resected along with adherent part of urinary bladder wall. Histopathological examination shows- Spindle Cell Neoplasm Favouring Gastro Intestinal Stromal ( GIST )Tumour.
Conclusions: This report describes a patient with acute diffuse peritonitis due to spontaneous rupture of a primary GIST of the proximal ileum.