Gastrointestinal stromal tumour (GIST) developing from the lower horizoltal part of the duodenum causing gastrointestinal bleeding

Introduction: In the past 8 years in our department we carried out 13 operations because of GIST in different localisation. 9 of them originated from the stomach, 1–1 from the oesophagus, the distal part of the jejunum and the rectum. According to relevant statistical data the GISTs are represent about 1% of all gastrointestinal tumours, and only 1% of them are originated from the duodenum. That is why we consider our case to be a rarity.

Case Report: A 78 year old female patient applied for check-up at her family doctor (GP) with the complains that she is easily tired and feel weakness in December 2004. A slight anaemia, and occult blood in her stool was observed, so a gastric x-ray examination was carried out, which didn't show any disorder. After this we carried out a gastro-duodenoscopy, during which in the distal part of the duodenum an ulceration was seen.

The result of histology examination of biopsy specimen showed only duodenitis. An abdominal CT scan was carried out than, which demonstrated a duodenal tumour with a 7cm diameter. After these diagnostic procedures we carried out an operation, during which we found a tumour in the terminal part of the duodenum, starting just behind of the superior mesenteric artery and the ligament of Treitz. The resection of the duodenum was carried out. The postoperative period was eventless.

According to the regular histology and the immunhystochemical examinations the tumour represented an intermediary risk from the point of metastasis formation, and Glyvec medication therapy is indicated. In the future the regular oncological control examinations are mandatory.

Conclusion: The GIST originated from duodenum is a very rare. Surgical removal combined with postoperative Glyvec medication is a promising possibility in recovering.