Ömer ÇAĞLAYAN, Ahmet ÇEKİÇ, Mehmet YILDIRIM

TEKRARLAYAN İNTESTİNAL KANAMA NEDENİ: JEJUNUMUN STROMAL TÜMÖRÜ

Giriş: Gastrointestinal stromal tümörler, tüm gastrointestinal tümörler arasında nadiren görülmekte olup, özellikle jejunum yerleşimli olanlarının tanısı güç olmaktadır. Klinikte barsak perforasyonu, intestinal obstrüksiyon ve kanama gibi bulgulara yol açabilmektedir. Olgu: 57 yaşında erkek olup hematokezya ile başvurdu. Daha önce 3 kez tekrarlayan kanama nedeni ile tıbbi tedavi almıştı. Endoskopik olarak normal bulunan olguda BT de ince barsak ilişkili tümör bulundu. Ameliyatta jejunumdaki kitle parsiyal ince barsak rezeksiyonu ile çıkarıldı. Hastanın takiplerinde kanama yakınması kayboldu. Sonuç: Jejunal yerleşimli stromal tümörler nonspesifik semptomlar vermekte ve endoskopi ile erişimin mümkün olmaması gibi nedenlerle tanıları güç olmaktadır. Endoskopi ile etiyolojisi aydınlatılamayan tekrarlayan GIS kanamalarında etyolojide ince barsak stromal tümörleri düşünülmeli ve ileri görüntüleme yöntemleri kullanılmalıdır.

CAUSE OF RECURRENT INTESTINAL BLEEDING: STROMAL TUMOR OF THE JEJUNUM

Introduction: Gastrointestinal stromal tumors are rarely seen among all gastrointestinal tumors, and diagnosis is difficult, especially those located in the jejunum. In the clinic, it can lead to findings such as bowel perforation, intestinal obstruction and bleeding. Case: A 57-year-old male was admitted with haematochezia. He had received medical treatment for bleeding that recurred 3 times in his past. The patient was found to be normal endoscopically, but small bowel associated tumor was also found CT imaging. The jejunal tumor was removed with partial small bowel resection. The patient's complaint of bleeding disappeared in the follow-up. Conclusion: Jejunal GISTs symptoms are not spesific and access with endoscopy is not possible. Small bowel stromal tumors should be considered in the etiology of recurrent GI bleeding whose etiology cannot be clarified by endoscopy, and advanced imaging methods should be used.

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1. Søreide K, Sandvik OM, Søreide JA, Giljaca V, Jureckova A, Bulusu VR. Global epidemiology of gastrointestinal stromal tumours (GIST): A systematic review of population-based cohort studies. Cancer Epidemiology 2016; 40: 39–46.
2. Mantese G. Gastrointestinal stromal tumor: epidemiology, diagnosis, and treatment. Current Opinion in Gastroenterology 2019; 35(6): 555–9.
3. Zhou L, Liao Y, Wu J, Yang J, Zhang H, Wang X et al. Small bowel gastrointestinal stromal tumor: a retrospective study of 32 cases at a single center and review of the literature. Therapeutics and Clinical Risk Management 2018; 14: 1467–81.
4. Fletcher CDM, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ et al. Diagnosis of gastrointestinal stromal tumors: A consensus approach. Human Pathology 2002; 33(5): 459–65.
5. Miettinen M, Lasota J. Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Archives of Pathology&Laboratory Medicine2006; 130(10): 1466–78.
6. Tseng CM, Lin IC, Chang CY, Wang HP, Chen CC, Mo LR et al. Role of computed tomography angiography on the management of overt obscure gastrointestinal bleeding. PLOS ONE 2017; 12(3): e0172754.
7. Kapatia G, Gupta N, Saikia UN, Gupta P, Rohilla M, Gupta O et al. Fine needle aspiration cytology of primary and metastatic gastrointestinal stromal tumour. Cytopathology 2020; 31(2): 136–43.
8. Akahoshi K, Oya M, Koga T, Shiratsuchi Y. Current clinical management of gastrointestina lstromal tumor. World Journal of Gastroenterology 2018; 24(26): 2806–17.
9. Ortenzi M, Ghiselli R, Cardinali L, Guerrieri M. Surgical treatment of gastric stromal tumors: laparoscopic versus open approach. Annali Italiani di Chirurgia 2017;88: S0003469X17026112.
10. Baheti AD, Shinagare AB, O’Neill AC, Krajewski KM, Hornick JL, George S et al. MDCT and clinicopathological features of small bowel gastrointestinal stromal tumours in 102 patients: a single institute experience. The British Journal of Radiology 2015; 88(1053): 20150085.