Abstract
A 68-year-old man developed a fever and abdominal pain. He was referred to the Department of Surgery from the Department of Internal Medicine due to a provisional diagnosis of an intra-abdominal tumor. The laboratory data showed anemia and a high C-reactive protein (CRP) level ; the abdominal CT scan showed an 8×7×5 cm-sized tumor and intra-abdominal fluid. No abnormal findings were found on endoscopy. The patient was operated on under a diagnosis of rupture of an intra-abdominal tumor. At surgery, about 300 ml of bloody ascites was found in the abdominal cavity and a protruding tumor in the ileum located about 180 cm from the terminal ileum. Some clots were attached to the tumor, and a small amount of hemorrhage was observed. Thus, the tumor was determined to be the bleeding source ; partial resection of the small intestine including the tumor was performed. On immunohistochemical staining, a positive reaction only to c-kit was noted. Intra-abdominal bleeding due to rupture of a gastrointestinal stromal tumor of the small intenstine was diagnosed. After the operation, the patient was treated with imatinib mesylate 400 mg/day. The patient is doing well, 3 years after surgery.
