J Korean Soc Radiol.  2015 Apr;72(4):287-290. 10.3348/jksr.2015.72.4.287.

Spontaneous Rupture of Pedunculated Gastric Gastrointestinal Stromal Tumor into the Gastrocolic Ligament Presenting as a Stalked Mass Surrounded by Loculated Hematoma

• Kim HS
• Ahn SE
• Park SJ
• Moon SK
• Lim JW
• Lee DH
• Kim YH

• KMID: 1941760
• DOI: http://doi.org/10.3348/jksr.2015.72.4.287

Abstract

Gastric gastrointestinal stromal tumor (GIST) is one of the most common mesenchymal tumors of the stomach, which may be asymptomatic or cause symptoms such as pain, gastrointestinal bleeding, and obstruction. Hemoperitoneum due to spontaneous rupture of the tumor is an extremely rare complication. We described a case of a 52-year-old man with a large pedunculated GIST causing loculated hematoma within the gastrocolic ligament. The patient visited our hospital due to a 3 week history of epigastric pain. A computed tomography scan revealed a 10.3 x 7.5 x 9.4 cm sized mass that was growing exophytically from the greater curvature of the stomach and was surrounded by loculated hematoma within the gastrocolic ligament. Laparotomy revealed a large stalked gastric mass surrounded by loculated hematoma within the gastrocolic ligament and blood fluid in the peritoneal cavity. Pathologic examination confirmed a GIST, of the high risk group.

MeSH Terms

Gastrointestinal Stromal Tumors*
Hematoma*
Hemoperitoneum
Hemorrhage
Humans
Laparotomy
Ligaments*
Middle Aged
Peritoneal Cavity
Rupture, Spontaneous*
Stomach

Figure

• 

  Fig. 1 A 52-year-old man with a large pedunculated gastric gastrointestinal stromal tumor causing loculated hematoma within the gastrocolic ligament. A. The axial image of the contrast-enhanced abdominal CT scan reveals a heterogenous mass with a central area of low attenuation in the mid abdomen (arrow). There is peritumoral hematoma within the gastrocolic ligament (arrowhead) and loculated hemoperitoneum in the left inframesocolic space (asterisk). B. The coronal image demonstrates a stalk between the greater curvature of the stomach and the mass, which indicates that the mass is growing exophytically from the greater curvature of the stomach and the stalk contains the arteries supplying the mass (arrow). C. The sagittal image clearly demonstrates a stalk, which contains the gastric arteries (arrow). D. Laparoscopy reveals a large, mass surrounded by hematoma (asterisk) in the greater curvature side of posterior wall of the stomach. The blood was oozing from the mass. E. Macroscopic image of the surgical specimen after resection of the mass. The tip of the mass shows the stalk (asterisk) attached to gastric wall. The cut surface of the lobulated mass shows hemorrhage (arrows) and myxoid degeneration (square).

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