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Surgery and Anesthesia 2018 & Euro Gastro Congress 2018 Case Reports in Surgery and Invasive Procedures| Volume 2
&
GASTROENTEROLOGY
3rd International Conference on
SURGERY AND ANESTHESIA
International Conference on
Joint Event on
OF EXCELLENCE
IN INTERNATIONAL
MEETINGS
YEARS
Safi Khuri, Case Rep Surg Invasive Proced 2018, Volume 2
GASTROINTESTINAL STROMAL TUMOR
OF THE SMALL BOWEL; THE FORGOTTEN
CAUSE OF MASSIVE OBSCURE
GASTROINTESTINAL HEMORRHAGE
Gastrointestinal (GI) bleeding is a common surgical emergency, with an an-
nual incidence of 170 cases/100,000 adults. About 80% of GI bleeding is
due to upper GI pathology, with peptic ulcer disease being the most common.
Lower GI bleeding is usually due to colonic pathology. Obscure GI bleeding is
defined as hemorrhage that persists or recurs following negative endoscopy.
The reported rate of bleeding from the small bowel is 2-10%, with vascular
abnormalities account for 70-80% and small bowel tumors account for 5-10%.
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tu-
mor of the GI tract, and account for less than 1% of all GI tumors. The estimat-
ed frequency of GIST tumors is 10-20/ 1 million population. GIST most com-
monly arise in the stomach (60%-70%), followed by the small intestine, as the
second most common GI tract organ to be affected (20-25%). A retrospective
study over 7 years, between January 1, 2011 and December 31, 2017 was per-
formed at the general surgery department of Rambam Health Campus, Haifa,
Israel. All patients, older than 18 years, with a diagnosis of GISTwere included.
During the aforementioned period, data on 64 patients (n=64) with a diagnosis
of GIST were reported. 54.6% (n=35) patients had gastric GIST, 31.1% patients
(n=20) involving the small bowel, 6.2% (n=4) affect the peritoneum, 3.1% (n=2)
had rectal GIST, 3.1% (n=2) colon GIST and 1.5% (n=1) had retroperitoneal
GIST. Of patients with small bowel GIST, 50% (n=10) presented with GI hem-
orrhage, with 7 patients (35%) presented with massive obscure GI bleeding.
Most of these patients (5/7) presented initially with melena which become
cherry red rectal bleeding later. Average packed cells transfusion is 11.5 unit
(range 6 units- 23 units). There was no association between tumor size and
risk for blood transfusion, as the smallest tumor diameter reported was 0.7
cm receiving 23 packed cell units. 6 out of the 7 patients were diagnosed by
computed tomography angiography (CTA) and one was diagnosed during lap-
arotomy, reflecting the important rule for CTA in diagnosing such rare entity.
Biography
Safi Khuri, is a general surgeon at the department
of general surgery, Rambam health campus, Haifa,
Israel. He is now second year resident at the hepa-
topancreaticobiliary and surgical oncology unit.
He received a MD diploma from JUST (Jordanian
university of science and technology) university at
2010, and had been resident at the general surgery
department from 2012-2017. During his residency
he published several abstracts and studies, most
of themwere about surgical oncology. Of his ongo-
ing researches is the impact of elevated intra-ab-
dominal pressure on kidney injury in normal rats
and animals with congestive heart failure impac-
tion of urinary neutrophils gelatinase associated
lipocalin as a biomarker of acute kidney injury.
Safi Khuri
Rambam Health Campus, Israel