Gastric GIST: A Rare Cause of Upper GI Bleeding

Gastrointestinal stromal tumours are the most common mesenchymal tumours of the gastrointestinal tract. This case report highlights the necessity of early surgical intervention in such cases to avoid mortality due to bleeding and to raise the awareness of rare causes of upper gastrointestinal bleed and their management. A 19 year old male presented in the surgery department of Shaheed Suhrawardy medical College Hospital with complaints of recurrent episodes of melena with anorexia and weight loss for 6 months. Apart from anaemia no significant findings were noted on physical examination. Investigations including upper GI endoscopy was not conclusive. So he underwent laparotomy which revealed an exophytic growth along the lesser curvature. Lower partial gastrectomy was done and histopathological and immunohistochemistry report showed evidence of benign low risk GIST. As the tumor was benign with no malignant potential imatinib therapy was not advocated. J Shaheed Suhrawardy Med Coll 2020; 12(2): 119-122

P-EGS26 Outcomes of Surgical Treatment for Perforated Peptic Ulcer in a non-Upper Gastrointestinal Surgery Centre

Background Perforated peptic ulcer (PPU) remains a common surgical emergency worldwide requiring surgical intervention. Although commonly performed, morbidity and mortality rate remained high. This study aimed to analyze the factors that contribute to the outcome of PPU surgery in a non-upper gastrointestinal surgery center in Malaysia. Methods Data were collected by retrospective review of all PPU surgeries done throughout the year 2020, looking into various preoperative, intraoperative, and postoperative details. Results In this study, we have a total of 24 PPU patients underwent surgery resulted in 7 (29.2%) deaths. Majority of our subjects were elderly (median age 65 years, IQR 48.5 – 73.0) with 4 (16%) being of ASA (American Society of Anesthesiologist) category 3 - 4. The most common cause of death was uncontrolled systemic infection in 4 patients (57.1%), followed by 2 (28.6%) fatal arrhythmia and 1 (14.3%) massive upper gastrointestinal bleed. Our analysis found that size of perforation ≥ 30mm (OR = 0.18, 95%CI 0.08 - 0.44), and postoperative complications (OR = 12.5, 95%CI 1.6 – 97.6) were significantly associated with a higher postoperative death. Low serum albumin level (mean 34.3 ± 9.1g/L), negative base excess level (mean -3.28 ± 4.89), and prolonged interval between admission and commencement of surgery (median 750 mins, IQR 258 – 2218) were all significantly associated with increased mortality post PPU surgeries. Conclusions This study highlighted to us various perioperative factors which could potentially be modifiable thus necessary measures can be taken in the future to ensure a better operative outcome of PPU surgery.

A Case Report of a Bleeding Duodenal Gastro-Intestinal Stromal Tumor and its Emergent Management

A gastrointestinal stromal tumor (GIST) arising in the duodenum is a rare subtype of mesenchymal tumor. GISTs have a reported incidence of 11.9–19.6 per million population and duodenal GISTs make up just 5% of these tumors. Common presentation of duodenal GISTs is through an upper gastrointestinal bleed, of which, they are responsible for less than 1% of all gastrointestinal bleeding. In an elective setting, surgical management remains the mainstay of treatment. In this Case Report, the emergent management of a localized duodenal resection was performed by an acute care surgeon, in an unstable patient. The risk factors for malignancy include tumor size and a high mitotic cell index. Tumor recurrence is determined by tumor size, tumor rupture, high mitotic cell index, a non-gastric location and gastrointestinal bleeding.