Perforation Peritonitis by a Gastrointestinal Stromal Tumour of Jejunum: A Rare Presentation

Tumour perforation is accepted as a bad prognostic factor along with larger tumour size and higher mitotic index in gastrointestinal stromal tumours (GISTs). The prognosis is worse in patients with tumour perforation or rupture. We report an unusual case of a 5 cm GIST of the jejunum that presented with spontaneous rupture. A previously healthy 46-year-old male patient presented with sudden abdominal pain from last 3 days. Physical examination revealed features of peritonitis, and computed tomography showed a heterogeneous solid mass measuring approximately 5 cm x 5.5 cm arising from the distal jejunum with mild fluid in the peritoneal cavity. The mass was diagnosed as a GIST originating from the gastrointestinal tract. Emergency laparotomy was performed and intraoperative findings showed mild hemoperitoneum and an outgrowing mass from the distal jejunum. The tumour had ruptured away from the wall of the distal jejunum though no active bleed was note. Surgical resection of the tumour was performed and the patient was discharged home uneventfully on the third postoperative day. The immunohistochemical characteristics of the tumour revealed it to be a GIST.