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| Small Intestine |
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Rohitbhai Vasavada |
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| Case |
A 45 year doctor from Modasa, Gujarat presented with anemia (Hb 6.5 gm%) in May 1998. His investigations revealed occult blood loss in the stools. Gastroscopy and colonsocopy was normal. Barium meal followup examination showed irregularity in the small bowel in the jejunal loops. A CT Scan showed a mass in the left lumbar region. |
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He underwent laparotomy by Dr. Sanjiv Haribhakti on 16th July 1998. He was found to have 8 x 8 cm. mass arising from proximal jejunum, adherent to descending colon, which was completely resected. Cut section showed an ulcer eroding into the mass. Postoperatively developed gastric atony for 7 days and fully recovered. . Histopatholgy revealed smooth muscle tumour with haemorrhage and necrosis. All lymphnodes were free of tumour. |
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He developed a recurrent tumour seen on followup sonogram in March 1999, for which he was reoperated on 8th March, 1999 by Dr. Sanjiv Haribhakti. A tumour was found arising from the jeunum. Complete en bloc excision of tumour was achieved. |
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Postoperative course was uneventful. Histopathology was low grade leiomyosarcoma, all lymphnodes were free. A review of Hp revealed low grade Gastrointestinal stromal tumour (GIST). An opinion was taken from MD Anderson cancer center , USA for adjuvant chemotherapy, and was opined that there is no role of adjuvant chemotherapy or radiation therapy. |
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He developed another recurrence with a large incisional hernia in December 2000, which was again operated by Dr. Sanjiv Haribhakti. Multiple large intra abdominal and subcutaneous tumours were removed. Few tumours in the mesentry could not be resected. Incisional hernia was repaired by mesh hernioplasty. Histopathology was leiomyosarcoma high grade. |
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From jan 2001 to July 2001, chemotherapy with Adriamycin, Decarba and Holoxan gien without much response. In March 2001, sonography revealed recurrent lesions in jejunum and metastatic lesion in liver. |
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| Preop. CT Scan showing tumour in the bowel |
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Intraoperative photo of Recurrent tumour |
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