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Khirurgii

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Year 2020 Vol. 28 No 1

CASE REPORTS

N.A. TRIFANOV, A.JA. KOROVIN

GASTROINTESTINAL STROMAL TUMOR IN SMALL INTESTINE INVAGINATES

Kuban State Medical University 1, Krasnodar,
The Russian Federation

Gastrointestinal stromal tumors (GISTs) make up 0.1-3% of all cancers of the gastrointestinal tract and belong to the most common mesenchymal tumors of the small intestine. The diagnosis is more often established during an emergency operation undertaken for intestinal obstruction, bleeding or peritonitis. The clinical case of a patient with GIST of the small intestine complicated by intussusception is described. Difficulties of diagnostics and choice of treatment tactics of this pathology in the patient with severe accompanying neurological pathology with application of mini-invasive interventions are shown. The diagnosis of acute intestinal obstruction and the decision on surgical treatment were complicated by the remitting nature of obstruction with the passage of contrast to the colon, the version about the dynamic nature of intestinal obstruction against the background of tetraparesis. Negative clinical dynamics was an indication for laparoscopy, which made it possible to establish a diagnosis of intussusception of small bowel obstruction. Attempts to perform disinfection laparoscopically failed. Disinvagination and resection of the small intestine, with a tumor found in invaginate, are made of mini-laparotomic access using the mini-assistant apparatus. Immunohistochemical study of the removed specimen: malignant GIST of the jejunum, epithelioid variant. The biological properties of the tumor (absence of lymphogenic metastasis, extremely low incidence of infiltrative growth) allow the use of minimally invasive interventions without deterioration of the overall and relapse-free survival. Minimally invasive surgeries for tumors of the small intestine are rather rare, and cases of their use in complicated course of the disease are not described. This clinical case is of interest due to the atypical course of intestinal obstruction, its causal relationship with GIST and minimally invasive approach to the diagnosis and treatment of the presented pathology.

Keywords: GIST, intestinal obstruction, intussusception, diagnosis, laparoscopy, minimally invasive surgery
p. 100-105 of the original issue
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Address for correspondence:
350063, Russian Federation,
Krasnodar, Mitrophan Sedin Str., 4,
Kuban State Medical University,
Department of Faculty and Hospital Surgery.
Tel. +7 961 581-25-23,
e-mail: nikolaysv26@mail.ru,
Nikolay A. Trifanov
Information about the authors:
Korovin Alexander Ja., MD, Professor, Department of Faculty and Hospital Surgery, Kuban State Medical University, Krasnodar, Russian Federation.
http://orcid.org/0000-0002-7986-4455
Trifanov Nikolay A., Post-Graduate Student, Department of Faculty and Hospital Surgery, Kuban State Medical University, Krasnodar, Russian Federation.
http://orcid.org/0000-0001-9006-6860
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