Perforation as an uncommon clinical presentation of gastric gastrointestinal stromal tumor: A case report

Abstract

Gastrointestinal stromal tumors (GISTs) represent the most common mesenchymal neoplasms of the digestive tract. While they can arise at any location along the gastrointestinal tract, the stomach is the most frequent site of origin, followed by the small intestine. We report the case of a 64-year-old male from North Africa with a 4-month history of dull, persistent epigastric pain, which intensified into severe stabbing pain in the 48 h preceding presentation. On admission, he developed signs of acute peritonitis, including diffuse abdominal pain, cessation of stool and gas passage, and hemodynamic instability. Imaging revealed a perforated gastric mass with central necrosis, pneumoperitoneum, and hepatic metastases. Emergency laparotomy confirmed tumor rupture and widespread peritoneal contamination. Despite urgent surgical intervention, the patient succumbed to refractory septic shock within 24 h. This case underscores the necessity of maintaining a high index of suspicion in the evaluation of atypical abdominal emergencies and highlights the value of a prompt, multidisciplinary approach. Early diagnostic work-up combined with timely oncologic intervention was critical in establishing the diagnosis and guiding appropriate management. Such strategies are imperative to optimize clinical outcomes and minimize morbidity and mortality in patients with complex or atypical presentations of GISTs.