A Gastrointestinal Stromal Tumor of the Stomach with Massive Ascites secondary to Arterioportal Fistula Syndrome

Sosuke Tadano, Hideo Terashima, Reiji Nozaki, Nobuhiro Ohkohchi, Masanari Shiigai* and Manabu Minami*

Department of Surgery and Department of Diagnostic Radiology*, Advanced Biomedical Applications, Graduate School of Comprehensive Human Sciences, University of Tsukuba

We report a rare case of gastrointestinal stromal tumor (GIST) of the stomach accompanied by massive serous ascites associated with arterioportal fistula syndrome (APFs). An 85-year-old man hospitalized with abdominal distension was found to have a gastric tumor with massive ascites. Cytological examination of ascites by abdominal puncture showed no evidence of malignancy. Contrast-enhanced computed tomography showed a 10 cm mass closely contacting the lesser gastric curvature. Vascular reconstruction by three-dimensional modeling showed that a large amount of contrast medium had flowed into the portal vein proximal to the liver through a tumor-draining vein and left gastric vein during the arterial phase. This indicated that the tumor itself functioned virtually as an arteriovenous shunt and overloaded the portal venous flow, which may have induced massive ascites. Total gastrectomy was conducted in February 2006, yielding a pathological diagnosis of uncommitted high-risk GIST originating in the stomach. After surgery, ascites disappeared and no evidence of recurrence has been seen in the 12 months to date. The pathogenesis of massive ascites in this case was thought to be compatible with APFs. A Web search of the Japanese and English literature did not show any previous reports of GIST with APFs, making the presentation of this case significant and necessary.

Key words
GIST, massive serous ascites, arterioportal fistula syndrome

Reprint requests
Sosuke Tadano Department of Gastroenterological Surgery, University of Tsukuba
1-1-1 Tennodai, Tsukuba, 305-8577 JAPAN

Accepted
September 26, 2007

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