Multiple gastrointestinal stromal tumors of the duodenum and proximal jejunum: an unexpected finding in an emergency laparotomy

Gastrointestinal stromal tumors (GISTs) of the duodenum are relatively rare and difficult to diagnose in early stage because it lacks pathognomonic symptoms. Here, we report a case of multiple GISTs involving the third and fourth portions of the duodenum and proximal jejunum, which were revealed in an emergent laparotomy. A 40-year-old, previously healthy man was referred to the Emergency Department with perineal trauma and diagnosed with a rectal perforation. The rectal perforation was repaired and solid nodules were detected on the proximal jejunum during the laparotomy that proved to be GISTs after histological examination. The patient was then readmitted and an enhanced CT of the abdomen revealed two smooth-outlined solid masses in the fourth part of the duodenum, but no mass was found on the proximal jejunum. During laparotomy, there were two solid masses located on the third portion of duodenum and about 30 solid nodules on the proximal jejunum that were not revealed by the preoperative CT scan. A local resection and primary closure was performed on the four isolated GISTs on the third and fourth portions of the duodenum. The proximal jejunum (~35 cm) with crowed solid tiny nodules was removed and a feeding catheter was placed in the jejunum distal to the anastomosis for postoperative feeding. Local or segmental resection is recommended when the lesions are located on the third and fourth portions of the duodenum according to literature review. A jejunal feeding catheter may be considered to prevent anastomotic leakage and to hasten recovery.