Clin Endosc.  2022 May;55(3):447-451. 10.5946/ce.2021.073.

Gastroduodenal intussusception of a gastrointestinal stromal tumor: a rare cause of acute pancreatitis

• Numpraphrut P
• Niltwat S
• Parakonthun T
• Pausawasdi N

• KMID: 2529968
• DOI: http://doi.org/10.5946/ce.2021.073

Abstract

Patients with symptomatic gastrointestinal stromal tumor (GIST) typically present with gastrointestinal bleeding and abdominal pain. This report presents an unusual case of fundic GIST complicated by gastroduodenal intussusception, manifesting as acute pancreatitis. The patient presented with epigastric pain and pancreatic enzyme elevation; thus, he was diagnosed with acute pancreatitis. Computed tomography showed evidence of pancreatitis and a 4×4.7 cm well-defined hyperdense lesion in the 2nd part of the duodenum, compressing the pancreatic head and pancreatic duct. Esophagogastroduodenoscopy revealed invagination of the gastric folds into the duodenum, causing pyloric canal blockage consistent with gastroduodenal intussusception. Spontaneous reduction of the lesion during endoscopy revealed a 4 cm pedunculated subepithelial mass with central ulceration originating from the gastric fundus. Endoscopic ultrasound demonstrated a heterogeneous hypoechoic lesion originating from the 4th layer of the gastric wall. Laparoscopic-endoscopic intragastric wedge resection of the fundic lesion was subsequently performed, and surgical histology confirmed GIST.

Keyword

Acute pancreatitis; Gastroduodenal intussusception; Gastrointestinal stromal tumor

Figure

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  Fig. 1. (A) Computed tomography scan of the abdomen revealed a 4×4.7 cm well-defined hyperdense tumor in the 2nd part of the duodenum, edematous change of the pancreatic parenchyma, and peripancreatic fat stranding. (B) The mass was originated from the gastric fundus.

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  Fig. 2. Endoscopic images of the lesion. (A) Twisting of the gastric folds in the gastric cardia and fundus. (B) Torsion of the gastric folds running across the incisura into the pyloric canal. (C) A 4-cm sized, pedunculated subepithelial lesion arising from the fundus was visualized after spontaneous reduction of the intussuscepted gastric folds. (D) Endoscopic ultrasound of the subepithelial lesion demonstrating a heterogeneous hypoechoic mass originating from the 4th layer of the gastric wall.

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  Fig. 3. (A) Pathologic examination showed spindle-shape cells on hematoxylin & eosin stain. Immunohistochemical staining of the specimen was positive for (B) CD117, (C) CD34, and (D) DOG-1, respectively. All images were taken in high-power-field magnification (x400).

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