41 year old man presented with severe melena for 2 days . He was transfused as his Hb dropped to 5.1 g/dl . Earlier he had a similar episode when he was investigated . Upper G.I Scopy was normal . Colonoscopy showed few diverticulae .So it was presumed that bleeding was from the diverticula in a different institution . This time CECT was done which showed GIST from the ileum. ( 3.X 3.3cm ). He is not hypertensive and not diabetic but overweight . Preoperative echo cardiography showed vegetation over the aortic valve . He did not give history of rheumatic heart disease .
The risk of GI bleed from the GIST is far more than his cardiac disease. I feel surgery can be safely offered under appropriate antibiotic cover which can be continued for 6-8 weeks as indicated for IE.
Bleeding indicates on tumor necrosis. Necrotic tumor was the site of entry for infection that caused infective endocarditis. Recurrence of bleeding and infectious complications is absolute indications for surgery - removal of the tumor and treatment of infective endocarditis.
I would take it out but use a minimal invasive route. If appropriate antibiotic profylaxis is given an continued this is possible with no major risk. The laparoscopy gives the possibility of larger exploration through a small incision. You will lose the tactile component but as an expert Lap Surgeon this will only be a minor disadvantage.
The minimal-invasive way seems to be weel in place in this patient, reducing postoperative trauma and risk of infection. If the intraoperative localisation of the tumor should be a problem, a HALS approach (Hand-Assisted with a GelPort) could be an option.
After stabilising the general condition of the patient Total Laparoscopic ileal resection containing the GIST was done .Postoperative recovery was uneventful and he was discharged on 4 th postoperative day. Histopathology showed that it was low grade spindle cells gastrointestinal stromal tumour and immune histochemistry confirmed that it was C-KIT positive gastrointestinal stromal tumour .
- Badges
- Science topic
- Similar topics
- Biological Science
- Microbiology
- Virology
- Virus