A Case of Gastrointestinal Stromal Tumor with the Operation for the Intestinal Perforation during the Treatment for Imatinib Mesilate

Masahiro Tsujiura¹⁾²⁾, Noriaki Koizumi²⁾, Atsusi Touma²⁾, Yosiki Itokawa²⁾, Takanori Ueki²⁾, Kenji Tsukamoto²⁾ and Eigo Otsuji¹⁾

Department of Surgery and Division of Digestive Surgery, Kyoto Prefectural University of Medicine¹⁾
Department of Surgery, Nantan General Hospital²⁾

A 77-years-old woman seen for lower abdominal discomfort in May 2005 was found in abdominal CT and MRI to have liver tumors, multiple tumors in the abdominal cavity, and right inguinal tumors. Based on a pathological diagnosis of gastrointestinal stromal tumor (GIST) from the resected right inguinal tumor. We started treatment with 400 mg/day of imatinib mesilate from the end of July 2005. After abdominal pain and fever appeared in mid September 2005, abdominal CT showed free air, necessitating laparotomy based on a diagnosis of gastrointestinal tract perforation. We confirmed that ileal tumor necrosis had caused the perforation and resected the small intestine, including the perforated region. We also resected as many abdominal tumors as possible to prevent the recurrence of tumor bleeding and perforation and to reduce the tumor volume. Pathological examination confirmed bleeding, degeneration, and decreased cell density in tumors, so we concluded that the perforation was caused by tumor reduction as an effect of imatinib mesilate. We further concluded that, in using imatinib mesilate to treat GIST, attention should be paid to possible digestive tract perforation, a critical side effect of imatinib mesilate.

Key words
gastrointestinal stromal tumor (GIST), imatinib mesilate, intestinal perforation

Reprint requests
Masahiro Tsujiura Department of Digestive Surgery, Kyoto Prefectural University of Medicine
465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyou-ku, Kyoto, 602-8566 JAPAN

Accepted
September 24, 2008

To read the PDF file you will need Abobe Reader installed on your computer.