Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.601
Peer-review started: October 3, 2023
First decision: December 6, 2023
Revised: December 28, 2023
Accepted: January 16, 2024
Article in press: January 16, 2024
Published online: February 27, 2024
Processing time: 144 Days and 22 Hours
Gastric stromal tumors, originating from mesenchymal tissues, are one of the most common tumors of the digestive tract. For stromal tumors originating from the muscularis propria, compared with conventional endoscopic submucosal dissection (ESD), endoscopic full-thickness resection (EFTR) can remove deep lesions and digestive tract wall tumors completely. However, this technique has major limitations such as perforation, postoperative bleeding, and post-polypec
A 47-year-old male patient had a hemispherical protrusion found during gastric endoscopic ultrasonography, located at the upper gastric curvature adjacent to the stomach fundus, with a smooth surface mucosa and poor mobility. The lesion was 19.3 mm × 16.1 mm in size and originated from the fourth ultrasound layer. Computed tomography (CT) revealed no significant evidence of lymph node enlargement or distant metastasis. Using conventional ESD technology for mucosal pre-resection, exposed EFTR was performed to resect the intact tumor in order to achieve a definitive histopathological diagnosis. Based on its morphology and immunohistochemical expression of CD117 and DOG-1, the lesion was proven to be consistent with a gastric stromal tumor. Six days after exposed EFTR, CT showed a large amount of encapsulated fluid and gas accumulation around the stomach. In addition, gastroscopy suggested intracavitary bleeding and abdominal puncture drainage indicated serosal bleeding. Based on these findings, the patient was diagnosed with serosal bleeding resulting in encapsulated abdominal hemorrhage after exposed EFTR for a gastric stromal tumor. The patient received combined treatments, such as hemostasis under gastroscopy, gastrointestinal decompression, and abdominal drainage. All examinations were normal within six months of follow-up.
This patient developed serous surface bleeding in the gastric cavity following exposed EFTR. Serosal bleeding resulting in an encapsulated hemoperitoneum is rare in clinical practice. The combined treatment may replace certain surgical techniques.
Core Tip: Postoperative bleeding is a common complication after exposed endoscopic full-thickness resection (EFTR), and is most commonly seen in the gastrointestinal tract. In the present case, following exposed EFTR for a gastric stromal tumor, bleeding was noted in both the gastric cavity and the serosal surface, which resulted in an encapsulated hemoperitoneum. The patient subsequently recovered after comprehensive treatment with gastrointestinal decompression, endoscopic hemostasis, B-ultrasound-guided abdominal puncture drainage, and anti-infection therapy.