Spontaneous hemoperitoneum by the rupture of a large stromal gastric tumour

The 48 year old patient, admitted to the Clinic IV for Digestive Surgery – Emergency University Hospital, presenting with symptoms of acute abdomen: intense diffuse abdominal pain, paleness of tissue and mucous membranes, nausea and vomiting. Pain started abruptly and agressively in the epigastrium 12 hours before admission to the hospital and then it spread to the abdomen, analgezic, not responding to the usual analgesic treatment. The anamnesis showed the patient repeatedly accused pain in the superior abdominal compartment, associated with nausea and vomiting, interpreted as dyspeptic syndrome of (probably) biliary etiology, responsive to the antispastic treatment. Intraoperatively, a diagnostic was established: hemoperitoneum due to the spontaneous rupture of a voluminous tumor (>10 cm), with extraluminal evolution in the gastric fornix and the macroscopic outlook of a GIST. Total gastrectomy is performed, with DII lymph node dissection (lymphadenectomy) and reconstruction of digestive continuity through Roux-en-Y eso-jejunal-anastomosis. The anatomo-pathological exam highlighted a gastrointestinal stromal tumor (GIST), TNM staging: pT4; pN0 (0/17); LV0; Pn0; R0. The patient had a favourable evolution. Since this type of pathology is extremely rare and difficult to diagnose, we believed it would be useful to present and review its micro and macroscopic aspects.