İntestinal obstrüksiyon yapmış Tümör Bağırsak Fistülü olan Gastrintestinal Stromal Tümör olgusu

Öz

Tümör içine barsak fistülizasyonu oldukça ender görülen bir durumdur. Olgumuz 51 yaşında kadın hasta kusma zayıflama ve karında şişlik şikayeti ile acil servisimize baş vurdu. Yapılan tetkikleri sonucunda tüm pelvisi kaplayan, bağırsak içeriği tümör içine fistülize olan ve barsak obstrüksiyonu yapan kitle tespit edildi. Kadın doğum ve üroloji uzmanlarının katılımı ile hasta 5.6.2015 tarihinde acil olarak ameliyata alındı. Tümöral kitlenin mesaneye infiltre ve incebağırsağa fistülize olduğu saptandı. Kitle total olarak çıkarıldı. Parsiyel sistektomi ve tamir,kısmi incebarsak rezeksiyonu ve uç uça anastomoz yapıldı. Hasta sorunsuz olarak postoperatif 10. gün taburcu edildi. Patolojik tetkikte 18X15X11 cm'lık kitle ince bağırsağa 2,5 cm lik bir alanda yapışık olduğu ve fistül ağzına benzer bir alan saptandı. Tümör orta bölgesinde nekroz ve nodüler yapıda idi. Yüksek riskli Gastrointestinal Stromal Tümör (GİST) tanısı konmuştur. Jejunum duvarından kaynaklandığı ince bağırsak kas tabakası ve mesane serozası ve dış kas tabakasına invaze olduğu saptanmıştır. Mitoz sayısı 5/50 BBA idi. Literatürde bu tip tümörlere ender olarak büyük GİST tümörlerinin tedavisi esnasında saptandığı bildirilmiştir. Olgumuzda ise çok daha ender görülen tedavi görmediği halde spontan olarak tümör barsak fistülizasyonu geliştiği saptanmıştır. Bu çalışmamızda büyük GİST tümörlerinde bağırsak fistülizasyonunun çok ender olsa da görülebileceği vurgulandı.

Anahtar Kelimeler

• Tümör bağırsak fistülizasyonu
• Gastrointestinal Stromal Tümör (GİST)
• Akut İntestinal obstrüksiyon

A case of Gastrointestinal Stromal Tumor Intestinal Fistula causing intestinal obstruction

Öz

Intestinal fistulization into a tumor is a very rare condition. A 51-year-old female patient was admitted to our emergency department with complaints of vomiting, weight loss, and abdominal distension. A mass covering the entire pelvis, containing intestinal contents, and causing bowel obstruction was detected. With the participation of obstetricians and urologists, the patient was urgently operated on on June 5, 2015. It was determined that the tumoral mass infiltrated the bladder and fistulized into the small intestine. The mass was completely removed. Partial cystectomy and repair, partial small bowel resection, and end-to-end anastomosis were performed. The patient was discharged on the 10th postoperative day without any problems. Pathology revealed that the 18X15X11 cm mass was adherent to the small intestine in an area of 2.5 cm and had an area similar to the fistula mouth. The tumor had necrosis and nodularity in its middle region. The patient was diagnosed with a high-risk gastrointestinal stromal tumor (GIST). It has been determined that it originates from the jejunum wall, and invades the small intestine muscle layer and bladder serosa, and the outer muscle layer. The mitosis number was 5/50 BBA. In the literature, it has been reported that this type of tumor is rarely detected during the treatment of large GIST tumors. In our case, it was determined that tumor bowel fistulization developed spontaneously even though it did not receive treatment, which is much rarer. abdominal distension. A mass covering the entire pelvis, containing intestinal contents, and causing bowel obstruction was detected. With the participation of obstetricians and urologists, the patient was urgently operated on on June 5, 2015. It was determined that the tumoral mass infiltrated the bladder and fistulized into the small intestine. The mass was completely removed. Partial cystectomy and repair, partial small bowel resection, and end-to-end anastomosis were performed. The patient was discharged on the 10th postoperative day without any problems. Pathology revealed that the 18X15X11 cm mass was adherent to the small intestine in an area of 2.5 cm and had an area similar to the fistula mouth. The tumor had necrosis and nodularity in its middle region. The patient was diagnosed with a high-risk gastrointestinal stromal tumor (GIST). It has been determined that it originates from the jejunum wall, and invades the small intestine muscle layer and bladder serosa, and the outer muscle layer. The mitosis number was 5/50 BBA. In the literature, it has been reported that this type of tumor is rarely detected during the treatment of large GIST tumors. In our case, it was determined that tumor bowel fistulization developed spontaneously even though it did not receive treatment, which is much rarer.

Anahtar Kelimeler

• tumor intestinal fistulization
• gastrointestinal stromal tumor (GIST)
• acute intestinal obstruction

Kaynakça

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