International Journal of Clinical Medicine, 2013, 4, 485-487
Published Online November 2013 (
Open Access IJCM
Jejunal Stromal Tumor Revealed by a Digestive
Mountassir Moujahid1#, Issam Ennafae2, Mohamed Ghari2, Khalid Chekoura3, Youness Issaoui3,
My Hassan Tahiri1
1Dpartment of General Surgery, 5th Military Hospital, Guelmim, Morocco; 2Department of Radiology, 5th Military Hospital,
Guelmim, Morocc o ; 3Department of Reanimation, 5th Military Hospital, Guelmim, Morocco.
Received August 13th, 2013; revised September 15th, 2013; accepted October 10th, 2013
Copyright © 2013 Mountassir Moujahid et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Introduction: Gastro intestinal stromal tumors are rare which can arise at any age, mostly between 50 and 60 years old.
They are characterized by the expression on the surface of their cells, a specific gene c-kit. They can be located in any
segment of the digestive tract, with a preference for the stomach (60%). The jejunum location is found in 200% to 30%
of the cases. The originality of our observation is the revelation of a stromal jejunum tumor by a digestive bleeding.
Case Report: A 71-year-old man was admitted in emergencies for a low digestive plentiful bleeding with state of hy-
povolemia shock. Result: The operation was performed after stabilization of his dynamic state and blood transfusion
and we discovered a jejunal stromal tumor in operation. The follow-up was simple with a good evolution under treat-
ment by Imatinib. Conclusion: Stromal digestive tumors are rare which can interest all the segments of the digestive
tract and their diagnosis must be often evoked in front of any digestive bleeding.
Keywords: Gastro Intestinal Stromal Tumor; Jejunum Location; Digestive Haemorrhage; Diagnostic and Treatment
1. Background
Digestive stromal tumors are rare that could occur at any
age, often between 50 and 60. They are characterized by
the expression on the s urface of their cells, a specific gene
c-kit. They can be located in any segment of the digestive
tube, with a preference for the stomach (60%). The Je-
junal localization is found in 20% to 30% of the cases 1.
We report a case of a stromal jejunal tumor collaged in
the service of surgery in the 5th Military Hospital at
Gu e lmim i n Mor occ o.
2. Case report
A 71-year-old patient, without a particular pathological
history, was allowed in emergencies for epigastric distress
associated with episodes of bleedi ng of big ab undance. He
was in a state of shock with 5 g/1 of haemoglobin. After
preparation and transfusion by four globular sediment, an
oesogastroduodenal endoscopy was normal and no trace
of bleeding was found.
The pelvic abdominal scanner revealed a tissular mass
developed over the flexura o f a rig ht col o n (Figure 1).
The exploration by endoscopic video capsula is not yet
practised in our training. As the bleeding persist with 6 g/l
of haemoglobin, The patient is led to the surgical unit after
transfusion and stabilization of his hemodynamic state.
The laparotomy showed a colic distension diffused with a
lot of blood, there was no tumor at the right colon but we
found a tumor situated in 25 cm of the duodeno jejunal
angle. The intervention consisted on a segmental jejunal
resectio n and en d-to-end anastomo sis ( Figures 2 and 3).
There were no postoperative complications in the early
postoperative period. We started oral feeding on the sec-
ond postoperative day with a liquid diet. The patient was
discharged home on the forth postoperative day.
Pathological examination of the specimen revealed a
GIST originating from the jejunal wall that was composed
of fusiform cells. The mitotic index was 1 in 50 higher
fields. On immune histochemical examination, CD117
and smooth muscle actin was diffusely positive, S100 was
*Conflict of interests: The authors declare no conflict of interests.
The authors’ contributions: All the authors contributed to the writing
of this ma nuscript and read and a pproved the final.
#Corresponding author.
Jejunal Stromal Tumor Revealed by a Dige sti ve Hemorrha g e
Figure 1. Abdominal scanner showing a tissular tumor of
heterogeneous density developed in the right of flexura co-
Figure 2. Tumor in expenses of the jejunum.
Figure 3. Segmental jejunal resection taking the tumor.
focal positive, and desmin and CD34 were negative. The
immune histochemical study confirmed the GIST.
3. Discussion
GISTs are a group of rare tumours of the digestive tract,
that could occur at any age, often between 50 and 60 with
a sex ratio close to 1 [1,2.The etiologic factors are un-
known. They are mostly localized at the level of the
stomach (60%), the small intestine (25%) and the colon in
(5 to 10%) [3,4. The incidence of these tumours is about
1–2/100 0005. They represent less than 1% of the ma-
lignant tumors of the digestive tube, and 20% of the ma-
lignant tumors in the small intestine,excluding lympho-
The extra digestive forms, the mesenteric ones in par-
ticular, are very rare: less than 5% of all the digestive
stromal tumors. The stromal tumors of the small intestine
can be asymptomatic, of fortuitous discovery in the fall of
a morphological examination or during a surgical opera-
tion as it was the case of our patient. They can be revealed
by a digestive bleeding [1,2,5,6]. The tumors of the small
intestine represent the second cause of unexplained di-
gestive bleeding 5 to 10% of the cases after the angio-
dysplasias [2,7,8].
Immunocytochemically, some tumours show differen-
tiation toward smooth muscle, others toward nerve, some
toward histiocytes, a small group toward smooth muscle
and nerve, and another small group shows no differentia-
tion [9] (
cine/2011/985242/-B8). The tumor is a major or minor
component of certain rare syndromes, familial, and non
familial functioning paraganglioma, and GIST are un-
common tumors that occur mostly in a sporadic and iso-
lated form, occasionally as components of multiple neo-
plasia syndromes, either separately or together. Separately,
they occur in several inherited syndromes including mul-
tiple endocrine neoplasia [10], the GIST, lentigines, and
mast cell tumor syndrome. Together, they are variably
prominent components of three syndromes: the familial
paraganglioma and gastric GIST syndrome, neurofibro-
matosis type 1, and the Carney triad (syndrome with
paraganglioma-jejunal GIST combination). The two for-
mer conditions are inherited as autosomal dominant traits;
the later does not appear to be inherited and affects young
women predominantly [11].
The endoscopic video capsula plays an important role
in the diagnosis of stromal hemorrhagic tumors of the
small intestine. It is a simple and harmless examination,
that represents at present the examination of first intention
in the case of an unexplain ed digestiv e h aemorrhage after
normal oesogastro duodenal endoscopy and an ileo colo-
scopy 1,2,4,9,10.The endoscopic video capsula made it
possible to put the diagnosis of tumors of the small intes-
tine in 8%, 9% of the cases [1,2,9,11,12]. Surgery is the
primary treatment of choice and for a long time has been
the only effective treatment for GIST with overall 5-year
survival rates of 45% - 55% until 200 1 when Imatinib, a
Open Access IJCM
Jejunal Stromal Tumor Revealed by a Dige sti ve Hemorrha g e
Open Access IJCM
small molecule inhibiting the kinase activity of c-k it, was
recognized to be highly effective in metastasized GIST
and revolutionized the treatment of metastasized and/or
unresectable GIST [13,14]. The development of coelio
surgery allows an invasive mini curative resection surgery
in most cases [7,8,15,16].
4. Conclusion
In the case of an unexplained digestive haemorrhage after
norma l ga str o du o denal e nd os co py and a n il eo col osc o py,
it is necessary to think of the hemorrhagic tumors of the
small intestine, especially the stromal tumors. Their di-
agnosis was clearly improved by the advent of the endo-
scopic vide o capsula, which i s not yet c ommon practice in
our institution.
[1] I. Serraj, L. Amrani, I. Atitar, et al., “Jejunal Stromal
Tumor Revealed by a Digestive Bleeding: One More En-
doscopic Video Capsula,” GECB, Vol. 32, No. 12, 2008,
pp. 1022-1024.
[2] D. A. Sass, K. B. Chopra, S. D. Finkelstein, et al., “Je-
junal Gastrointestinal Stromal Tumor: A Cause of Ob-
scure Gastrointestinal Bleeding,” Archives of Pathology
& Laboratory Medicine, 2004, Vol. 128, No. 2, pp. 214-
[3] M. G. Lapalus, V. Hervieu, A. Crombe, et al., “Stromal
Tumor in the Small Intestine: A Multi Technical Diag-
nostic Approach by Video-Capsule and Entero Scanner,”
GECB, Vol. 29, 2005, pp. 1183-1185.
[4] L. M. Marín-Gómez, V. Vega-Ruiz, M. A. García-Ureña,
et al., “Diagnosis and Satisfactory Surgical Treatment of
a Jejuna Stromal Tumor,” Revista de Gastroenterología
de México, Vol. 73, No. 1, 2008, pp. 33-35.
[5] D. A. Sass, K. B. Chopra, et al., “Jejunal Gastrointestinal
Stromal Tumor Acause of Obscure Gastrointestinal
Bleeding,” Archives of Pathology & Laboratory Medicine,
Vol. 128, 2004, pp. 214-217.
[6] A. Neuhaus and R. J. Bold, “Images in Surgery. Small
Bowel Stromal Cell Tumor,” The American Journal of
Surgery, Vol. 179, No. 4, 2000, p. 252.
[7] G. Macaigne, J. F. Boivin, J. P. Colombu, et al., “Stromal
Tumor with Fibers in Hank of the Small Intestine Re-
vealed by a Digestive Bleeding,” GECB, Vol. 25, No. 6-7,
2001, p. 717.
[8] O. Ciobotaru, O. R. Ciobotaru and C. Dragomir, “Stromal
Tumors of Jejunaum and Ileum,” Revista Medico Chirur-
gicala a Societatii de Medici si Naturalisti din Iasi, Vol.
115, No. 1, 2011, pp. 111-115.
[9] A. K. Dhull, V. Kaushal, R. Dhankhar, et al., “The Inside
Mystery of Jejunal Gastrointestinal Stromal Tumor: A
Rare Case Report and Review of the Literature,” Case
Reports in Oncological Medicine, Vol. 2011, 2011, Arti-
cle ID: 985242.
[10] M. Kubokawa, K. Akahoshi, H. Matsuzaka, et al., “Je-
junal Stromal Tumor,” Gastrointest Endosc, Vol. 60, No.
4, 2004, pp. 600-601.
[11] M. L. Wall, M. A. Ghallab, M. Farmer, et al., “Gastroin-
testinal Stromal Tumour Presenting with Duodenal-Je-
junal Intussusceptions: A Case Report,” Annals of The
Royal College of Surgeons of England, Vol. 92, No. 7,
2010, pp. 32-34.
[12] R. R. Carter, S. N. Mundluru, D. J. Margolin, “Small
Bowel Gastrointestinal Stromal Tumor: An Unusual
Cause of Massive Lower Gastrointestinal Bleeding,” Am
Surg., Vol. 76, No. 2, 2010, pp. 229-231.
[13] M. A. Beltran and K. S. Cruces, “Primary Tumors of
Jejunum and Ileum as a Cause of Intestinal Obstruction:
A Case Control Study,” International Journal of Surgery,
Vol. 5, No. 3, 2007, pp. 183-191.
[14] Y. Oida, M. Motojuku, G. Morikawa, et al., “Laparo-
scopic-Assisted Resection of Gastrointestinal Stromal
Tumor in Small Intestine,” Hepato-Gastroenterology, Vol.
55, 2008, pp. 146-149.
[15] B. Landi, T. Lecomte, A. Berger, et al., “Treatment of
Digestive Stromal Tumors,” GECB, Vol. 28, 2004, pp.
[16] C. Caliskan, O. Makay and M. Akyildiz, “Massive Gas-
trointestinal Bleeding Caused by Stromal Tumour of the
Jejunum,” Canadian Journal of Surgery, Vol. 5, 2009, p.