Gastrointestinal stromal tumor leading to acute abdomen and hypovolemic shock in a trauma patient.

Gastrointestinal stromal tumors (GISTs) are among the rare tumors of gastrointestinal (GI) tract. GISTs occur respectively in the stomach, small intestines, colon and rectum, omentum and mesentery, esophagus, retroperitoneal space, and abdominal cavity. However, they may occur anywhere along the GI tract. Typically, these tumors generally do not cause symptoms; however symptomatic patients may show stomach pain, GI bleeding, and palpable abdominal masses. These patients usually undergo surgery for obstruction symptoms or some other diagnosis. Our patient was admitted to the emergency department with acute abdomen and hypovolemic shock due to fall. The patient underwent emergency surgery, which revealed active bleeding from a stomach tumor showing an exophytic pattern of growth. This patient was a 32-year-old male, and blood tests revealed a white blood cell count of 23.500/mm³ and a hemoglobin level of 7.9 gr/dL. The heart rate was 110 beats/minute. The chest radiograph showed no subdiaphragmatic free air, and abdominal ultrasound showed impression of a mass that could not be distinguished from the liver, along with closed perforation or hemangioma. During the surgical procedure, 1200 cc of blood was suctioned, and the exophytic tumor was removed completely. Histological analysis of the tumor showed GIST, and it was considered to be a ruptured tumor by the oncology consultant. The patient was applied imatinib for 3 years after the surgery, and the disease did not re-occur during this period. Our goal in this case study is to emphasize that trauma may not be necessarily the cause of acute abdomen for emergency patients but that it also may be caused by hypotension-associated hypovolemic shock or other causes, bleeding from a GIST along with tumor torsion.