Case of malena

A 32 y/o female presents with melena. Upper & Lower GI endoscopy was done which were wnl. Then CT scan was done which showed a vascular lesion in the small bowel loop which was indicative of GIST. Laparotomy was done which shows a 5*4 cm mass lesion in a small bowel diverticulum. What will you recommend now?



Most likely GIST - a 5'4" mass lesion ina small bowel diverticulum- Next step is resection en - bloc of the part of small intestine containing mass and diverticulum with at least 2 cms of margins of normal tissue

When laparotomy confirms of sizable mass why in the same process it was not removed and could have been tested it's Histopathology ? Now again resection .!!! It must be done at an earliest in view of the probality of acute diverticulitis. Gastrointestinal stromal tumors (GISTs) are uncommon cancers that start in special cells in the wall of the gastrointestinal (GI) tract, also known as the digestive tract. To understand GISTs, it helps to know something about the structure and function of the GI tract. Consult senior surgeon.

This is a case of gatro intestinal stomal tumour which can involve any part of gastro intestinal system but affects mainly stomach and intestine . It arises fro the special nerve cell of intestine. Main point is the limitation diagnostic modalities because USG can reveal 0% MRI. 0% CT. can give about 55% but the most effective is CT with angoiography about 70 ,% but most effective modality is double baloon enteroscopy. Usually does rise any symptom except the bleeding if in stomach bleeding in the form of haematomesis may be with Malena but if involved intestine only Malena is the symptoms Laparotomy with excision or resection ofvthe part of intestine with anastomosis followed by HPE.

Small localised GIST in diverticulam Adv diverticulatomy with enmass and send for hpe As it is malignant follow by chemoradiotherapy

Thanx dr Ashok Leel

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Surgical intervention required to remove and followed by chemoradiotherapy and regular monitoring and constant evaluation required to avoid any other complications.

Thanks Dr Shivraj Agarwal

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Resection and anastomosis of segment of intestine with mass lesion, histopathological examination of specimen


Bleeding from small bowel are difficult to locate . Good diagnosis and management.