Indian Journal of Cancer
Home  ICS  Feedback Subscribe Top cited articles Login 
Users Online :1239
Small font sizeDefault font sizeIncrease font size
Navigate here
  Search
 
  Next article
  Previous article 
  Table of Contents
  
Resource links
   Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
   Article in PDF (138 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   References
   Article Figures

 Article Access Statistics
    Viewed2724    
    Printed83    
    Emailed0    
    PDF Downloaded261    
    Comments [Add]    
    Cited by others 3    

Recommend this journal

 


 
LETTER TO EDITOR
Year : 2009  |  Volume : 46  |  Issue : 3  |  Page : 246-247
 

Enterocolic fistula associated with a gastrointestinal stromal tumor


Department of Surgery, Hormozgan University of Medical Sciences, Bandarabbas, Iran

Date of Web Publication25-Jun-2009

Correspondence Address:
S Mohammad Vahid Hosseini
Department of Surgery, Hormozgan University of Medical Sciences, Bandarabbas
Iran
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.52965

Rights and Permissions



How to cite this article:
Shamsaeefar A, Hosseini S M, Motazedian N, Razmi T. Enterocolic fistula associated with a gastrointestinal stromal tumor. Indian J Cancer 2009;46:246-7

How to cite this URL:
Shamsaeefar A, Hosseini S M, Motazedian N, Razmi T. Enterocolic fistula associated with a gastrointestinal stromal tumor. Indian J Cancer [serial online] 2009 [cited 2019 Sep 16];46:246-7. Available from: http://www.indianjcancer.com/text.asp?2009/46/3/246/52965


Sir

Gastrointestinal stromal tumors (GIST) are the most common primary mesenchymal tumors of the gastrointestinal (GI) tract. [1] GIST usually displace the adjacent organ and have rarely been reported with intraperitoneal rupture or organ invasion. [2],[3] The following case describes a 70-year-old male patient with anemia and chronic diarrhea, who underwent colonoscopic examination. The findings on colonoscopy revealed a large, enterocolic fistula at the spelnic flexure of the colon. Physical examination and Laboratory studies were unremarkable except for the presence of a vague lump in the left upper quadrant and hemoglobin of 7.8 g/dL, respectively. Ultrasonography and computed tomography (CT) showed a mass (8 x 8 cm) at the splenic flexure and a metastatic lesion in the liver. [Figure 1] and [Figure 2] Exploration revealed a large diverticulum, which contained a mass that originated from the proximal jejunum and adhered to the medial border of spelenic flexure, associated with entrocolic fistula. Large intraperitoneal and liver metastases were also found. The bowel walls along with the fistula tract were resected and repaired, but the patient was not physiologically suitable for resection of the metastatic lesions. The patient did well in the postoperative period on Imatinib (400 mg/day) during the six-month follow-up. Pathology showed a spindle stromal tumor with low mitosis that was positive for CD117 (Gist tumor). [Figure 3]

Enterocolic fistulas are usually caused by inflammatory conditions such as inflammatory bowel disease. This abnormal communication can also be caused by prior surgery, foreign bodies, pancreatitis, diverticulitis, and, most ominously, by malignancy. [4]

The most common sites of tumors are the stomach and small intestine. Most patients with GIST (70%) have symptoms, however, 10% of them are only detected at autopsy. The most common symptom of GIST is anemia due to bleeding from mucosal ulceration. [1],[5],[6]

According to our knowledge this presentation of the GIST tumor has been the first report, not only considering the site of occurrence, but also the aggressiveness of the tumor that caused the entrocolic fistula. However, fistula formation can also be explained by tumor pressure and intraperitoneal rupture of the diverticula in advanced GIST, although, in this case the patient had never developed any signs of tumor rupture in his past medical history.

Surgery is the definitive therapy for patients with GIST tumor, as radiotherapy and chemotherapy have not been found to be effective in its treatment . Imatinib a selective and competitive inhibitor of tyrosine kinase, has been found to a of metastatic and locally advanced GISTs. We did not resect the metastatic lesions and the patient received only Imatinib, with good response in follow-up. [6]

 
  References Top

1.Miettinen M, Lasota J. Gastrointestinal stromal tumors: Pathology andprognosis at different sites. Semin Diagn Pathol 2006;23:70-83.  Back to cited text no. 1  [PUBMED]  
2.Van der Zwan SM, De Matteo RP. Gastrointestinal stromaltumour: 5 years later. Cancer 2005;104:1781-8.  Back to cited text no. 2    
3.Judson I. Gastrointestinal stromal tumour (GIST): Biology andtreatment. Ann Oncol 2002;13:287-9.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Kumar A, West JC, Still, C, Komar MJ, Babameto GP. Jejunocolic fistula: An unreported complication of acquired immunodeficiency syndrome-associated lymphoma. J Clin Gastroenterol 2002;34:194-5.  Back to cited text no. 4    
5.Gold JS, De Matteo RP. Combined surgical and moleculartherapy: The gastrointestinal stromal tumor model. Ann Surg 2006;244:176-84.   Back to cited text no. 5    
6.D'Amato G, Steinert DM, Mc Auliffe JC, Trent JC. Update on biology and therapy of gastrointestinal stromal tumours. Cancer Control 2005;12:44-56.  Back to cited text no. 6    


    Figures

  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
1 Ileal GIST presenting with bacteremia and liver abscess: A case report and review of literature
Marina Gorelik,Braulio Sabates,Adel Elkbuli,Tony Dunne
International Journal of Surgery Case Reports. 2018; 42: 261
[Pubmed] | [DOI]
2 Early Enteral Nutrition Improves Outcomes of Open Abdomen in Gastrointestinal Fistula Patients Complicated With Severe Sepsis
Yujie Yuan,Jianan Ren,Guosheng Gu,Jun Chen,Jieshou Li
Nutrition in Clinical Practice. 2011; 26(6): 688
[Pubmed] | [DOI]
3 Early enteral nutrition improves outcomes of open abdomen in gastrointestinal fistula patients complicated with severe sepsis
Yuan, Y., Ren, J., Gu, G., Chen, J., Li, J.
Nutrition in Clinical Practice. 2011; 26(6): 688-694
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article

    

  Site Map | What's new | Copyright and Disclaimer
  Online since 1st April '07
  2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow