Abstract
We report a case of GIST of the duodenum with bleeding, in which pancreaticoduodenectomy (PD) was successfully performed after hemostasis was first accomplished by TAE. A 39-year-old female was admitted to our hospital with a history of melena. Abdominal CT revealed a hypervascular tumor measuring 40 mm in diameter in the medial part of the second portion of the duodenum. Upper gastrointestinal endoscopy showed bleeding from an exposed vessel in an ulcerated area of the submucosal tumor 2 cm distal to papilla Vater. The patient had previously undergone enucleation of a duodenal GIST at another hospital 7 years earlier, therefore, a recurrent duodenal GIST was suspected. Hemostasis was accomplished by local injection of some a hypertonic saline-epinephrine solution on the ulcer. Rebleeding occurred 7 days after the endoscopic treatment, therefore, TAE was attempted. PD was then performed safely 3 days after the TAE. The resected tumor was pathologically diagnosed as a GIST. TAE is considered to be effective pretreatment for bleeding duodenal GISTs in cases where a major surgical procedure like PD is required for resection of the tumor.
