Successful Endoscopic Drainage of a 20-cm Abscess in a Gastrointestinal Stromal Tumor of the Stomach

Abstract

A 63-year-old man was found to have an abscess in the dorsal stomach with a maximum diameter of 20 cm on computed tomography. Upper gastrointestinal endoscopy showed an elevated lesion in the posterior wall of the upper gastric corpus that was connected to the abscess by a fistula, and a submucosal tumor with abscess formation was diagnosed. The histopathological diagnosis was gastrointestinal stromal tumor (GIST), but the tumor and abscess were compressing the transverse colon, pancreatic tail, abdominal wall, and other organs, making total resection infeasible. A 7-Fr, 7-cm, double-pigtail stent was placed endoscopically in the abscess from the stomach via the fistula to create an internal fistula, and an 8.5-Fr transnasal drainage tube was also inserted to form an external fistula, draining the abscess to achieve decompression and infection control. The abscess decreased in size, enabling its complete removal by open total gastrectomy and partial transverse colectomy. The postoperative course was uneventful, and the patient was discharged on postoperative Day 13. Endoscopic drainage was an effective preoperative treatment in this case of gastric GIST with abscess formation.