• accurate diagnosis
• acute abdomen
• intestinal invagination
• intestine intussusception
• intestine obstruction
• jejunojejunal intussusception
• leiomyoma
• surgery
• treatment choices

• Jejunojejunal intussusception
• adjuvant therapy
• case report
• gastrointestinal stromal tumor
• pathological lead point
• postoperative diagnosis

• Humans
• Intussusception/etiology
• Intussusception/surgery
• Intussusception/diagnosis
• Intussusception/pathology
• Intussusception/diagnostic imaging
• Female
• Gastrointestinal Stromal Tumors/complications
• Gastrointestinal Stromal Tumors/pathology
• Gastrointestinal Stromal Tumors/surgery
• Gastrointestinal Stromal Tumors/diagnosis
• Middle Aged
• Jejunal Diseases/etiology
• Jejunal Diseases/surgery
• Jejunal Diseases/diagnosis
• Jejunal Diseases/pathology
• Tomography, X-Ray Computed
• Abdominal Pain/etiology

Gastric gastrointestinal stromal tumor (GIST) is the most common etiology of gastroduodenal intussusception. Although gastroduodenal intussusception caused by gastric GIST is mostly treated by surgical resection, the first case of gastroduodenal intussusception caused by gastric GIST was treated by endoscopic submucosal dissection (ESD) in Japan in 2017.

An 84-year-old woman presented with symptoms of postprandial fullness with nausea and occasional vomiting for a month. Initially, she visited a local clinic for help, where abdominal sonography revealed a space-occupying lesion around the liver, so she was referred to our hospital for further confirmation. Abdominal sonography was repeated, which revealed a mass with an alternating concentric echogenic lesion. Esophagogastroduodenoscopy (EGD) was performed under the initial impression of gastric cancer with central necrosis and showed a tortuous distortion of gastric folds down from the lesser curvature side to the duodenal bulb with stenosis of the gastric outlet. EGD was barely passed through to the 2nd portion of the duodenum and a friable ulcerated mass was found. Several differential diagnoses were suspected, including gastroduodenal intussusception, gastric cancer invasion to the duodenum, or pancreatic cancer with adherence to the gastric antrum and duodenum. Abdominal computed tomography for further evaluation was arranged and showed gastroduodenal intussusception with a long stalk polypoid mass 5.9 cm in the duodenal bulb. Under the impression of gastroduodenal intussusception, ESD was performed at the base of the gastroduodenal intussusception; unfortunately, a gastric perforation was found after complete resection was accomplished, so gastrorrhaphy was performed for the perforation and retrieval of the huge polypoid lesion. The gastric tumor was pathologically proved to be a GIST. After the operation, there was no digestive disturbance and the patient was discharged uneventfully on the 10th day following the operation.

We present the second case of gastroduodenal intussusception caused by GIST treated by ESD. It is also the first case report of gastroduodenal intussusception by GIST in Taiwan, and endoscopic reduction or resection is an alternative treatment for elderly patients who are not candidates for surgery.

• Gastric gastrointestinal stromal tumor
• Endoscopic submucosal dissection
• Gastro-duodenal intussusception
• Elderly
• Esophagogastroduodenoscopy
• Gastrointestinal obstruction
• Case report

Massive intraluminal bleeding requires urgent intervention and management. However, the source of bleeding on the small intestine is difficult to determine. Intestinal tumor with intussusception is a rare and normally not an urgent condition. Herein, we present a rare case of intestinal intussusception with massive bleeding due to jejunal gastrointestinal stromal tumor (GIST) that required emergency surgical treatment.

A 51-year-old male was admitted to the emergency department complaining of abdominal pain and acute hematochezia. Esophagogastroduodenoscopy (EGD) and colonoscopy could not determine the source of the bleeding site. Abdominal pelvic computed tomography (AP-CT) revealed GIST with intussusception, strongly suggestive of distal jejunal bleeding. Unresponsive transfusion with low blood pressure and continuous hematochezia led to emergency laparotomy. GIST, which was the leading point for intussusception, was located in the jejunum and showed mucosal ulceration of approximately 3.5 cm in diameter. Following resection and functional anastomosis, histology revealed a GIST with low mitotic count (< 5 per 50HPF). Moreover, immunochemical analysis revealed positivity for c-kit (CD117) and DOG-1. There were no complications 2 months after surgery.

Intussusception associated with GIST is a rare finding that can be life-threatening if it occurs with an ulcer. This case showed that the early detection of bleeding and emergency surgery could prevent severe complications.

• Bleeding
• Gastrointestinal stromal tumor
• Intussusception

•

Gastrointestinal stromal tumor (GIST) in the third portion of the duodenum is rare.

Gastrointestinal stromal tumors (GISTs) in the third portion of the duodenum are rare. Intussusception and obstruction are rarely caused by GISTs because of their tendency to grow in an extraluminal manner. Herein, we report a case involving segmental duodenectomy in a patient with duodenojejunal intussusception secondary to a primary GIST.

A 91-year-old woman with a history of iron-deficiency anemia presented with vomiting and anorexia. Preoperative imaging suggested duodenojejunal intussusception secondary to a GIST in the third portion of the duodenum. Segmental duodenectomy with end-to-end duodenojejunostomy without reduction of the intussusception was performed. At 6 months after the surgery, the patient’s anemia had improved and she had no abdominal symptoms.

Adult intussusception requires surgical resection because most of the patients have intraluminal lesions. The location in relation to the Vater papilla, tumor size, and resection margin should be considered when selecting the type of surgical resection for duodenal GIST. Limited resection appears to be better than pancreaticoduodenectomy with respect to postoperative complications. Considering the age and performance status of this patient, a less invasive maneuver was selected.

Duodenal GISTs can be a rare cause of intussusception. Thus, a limited surgical resection procedure should be considered in such cases.

• Case report
• Duodenectomy
• Gastrointestinal stromal tumor
• Intussusception

• Gastrointestinal Hemorrhage
• Gastrointestinal Stromal Tumors
• Intussusception
• Small Intestine