Spontaneous rupture of an extremely large gastrointestinal stromal tumor of the jejunum

In a case of unexplained digestive hemorrhage after normal gastroscopy and colonoscopy, it is necessary to consider hemorrhagic tumors of the small intestine, particularly stromal tumors. We describe the case of a 73-year-old woman who presented with symptoms of massive hematochezia and abdominal pain. Abdominal examination revealed: distension, board-like rigidity, and muscular defense in the right upper quadrant; no liver dullness; and inaudible bowel sounds. In addition, rectal examination revealed an empty ampulla. Colonoscopic and gastroscopic evaluations were normal and did not reveal the origin of the bleeding. An abdominal enhanced computed tomography scan revealed a 9.2 cm × 10 cm solid tumor with a low-density area, suggesting necrosis or abscess. After the overall examination, a gastrointestinal stromal tumor (GIST) of the jejunum was highly suspected. Intraoperative findings showed an excessive bloody fluid collection, approximately 1600 mL in the abdominal cavity. Furthermore, an outgrown mass ruptured in the jejunum, ∼5 cm from the Treitz ligament. We deemed the tumor to be a moderately differentiated GIST originating from the jejunum. In this report, we review the literature on this rare condition and discuss potential strategies for diagnosing and managing patients with a spontaneous rupture of an extremely large GIST of the jejunum.