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CASE REPORT

Enteroscopic Tattooing for Better Intraoperative Localization of a Bleeding Jejunal GIST Facilitates Minimally Invasive Laparoscopically-assisted Surgery

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Razvan Iacobl, Anca Dimitriul, Oana Stanciulea2, Vlad Herlea3, Irinel Popescu2, Cristian Gheorghel

1) Center of Gastroenterology and Hepatology;
2) Dan Setlacec Center of General Surgery and Liver Transplantation;
3) Department of Pathology, Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest, Romania

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.251.gst

ABSTRACT

We present the case of a 63-year-old man that was admitted for melena and severe anemia. Upper GI endoscopy and colonoscopy failed to identify the lesion responsible for bleeding, and enteroCT scan was also non-contributive to the diagnosis. Capsule endoscopy indicated possible jejunal bleeding but could not indicate the source of bleeding, recommending anterograde enteroscopy. Single balloon enteroscopy identified a 2 cm submucosal tumour in the distal part of the jejunum, with a macroscopic appearance suggesting a gastrointestinal stromal tumour (GIST). The tumor location was marked using SPOT tattoo and subsequently easily identified by the surgeon and resected via minimally invasive laparoscopic-assisted approach. Histological and immunohistochemical analysis indicated a low risk GIST.
The unusual small size of the GIST as a modality of presentation, with digestive bleeding and anemia and the ability to use VCE/enteroscopy to identify and mark the lesion prior to minimally invasive surgery, represent the particularities of the presented case.

Key words: gastrointestinal stromal tumors – gastrointestinal obscure bleeding – single balloon enteroscopy – minimally invasive surgery.

Abbreviations: CA19-9: cancer antigen 19-9; CEA: carcinoembryonic antigen; GI: gastrointestinal; GIST: gastrointestinal stromal tumor; Hb: hemoglobin; HPF: high power field; MCH: mean corpuscular hemoglobin; MCV: mean corpuscular volume; VCE: videocapsule endoscopy.