An 82-year-old woman presented with acute abdominal pain, vomiting, and fever (38.8°C). One year earlier, she had an advanced gastrointestinal stromal tumor (GIST) with multiple intestinal and endoperitoneal localizations, not suitable for operation. Since then, she was treated with imatinib-mesylate, 400 mg once daily. On examination, her abdomen was diffusely tender with bulky elastic masses palpable in the middle and lower abdomen. Laboratory tests revealed moderate anemia (Hb 9.8 g/dL) with a white blood cell count of 16,200. Plain supine x-rays of the abdomen apparently showed some fluid levels with a marked dilatation of a bowel loop, simulating a closed-loop mechanical obstruction (A). CT scan showed neither bowel distention nor fluid levels, but there were contrast leaks from the small bowel communicating with large cavities (B, arrows). Urgent surgery was warranted. Multiple large soft masses, covered by inflamed serosa and containing gas and fluid, were found adhering to the small-bowel wall at laparotomy (C, arrows). Small, solid, nodular lesions were diffusely disseminated over the bowel wall and onto the peritoneum. An extended small-bowel resection with en bloc excision of the lesions and entero-entero anastomosis 386
Multiple bowel perforations complicating imatinib treatment for advanced gastrointestinal stromal tumor
CHIARUGI, MASSIMO;SECCIA, MASSIMO
2008-01-01
Abstract
An 82-year-old woman presented with acute abdominal pain, vomiting, and fever (38.8°C). One year earlier, she had an advanced gastrointestinal stromal tumor (GIST) with multiple intestinal and endoperitoneal localizations, not suitable for operation. Since then, she was treated with imatinib-mesylate, 400 mg once daily. On examination, her abdomen was diffusely tender with bulky elastic masses palpable in the middle and lower abdomen. Laboratory tests revealed moderate anemia (Hb 9.8 g/dL) with a white blood cell count of 16,200. Plain supine x-rays of the abdomen apparently showed some fluid levels with a marked dilatation of a bowel loop, simulating a closed-loop mechanical obstruction (A). CT scan showed neither bowel distention nor fluid levels, but there were contrast leaks from the small bowel communicating with large cavities (B, arrows). Urgent surgery was warranted. Multiple large soft masses, covered by inflamed serosa and containing gas and fluid, were found adhering to the small-bowel wall at laparotomy (C, arrows). Small, solid, nodular lesions were diffusely disseminated over the bowel wall and onto the peritoneum. An extended small-bowel resection with en bloc excision of the lesions and entero-entero anastomosis 386I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
