Case Report
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Surg. Dec 27, 2013; 5(12): 332-336
Published online Dec 27, 2013. doi: 10.4240/wjgs.v5.i12.332
A gastrointestinal stromal tumor of the third portion of the duodenum treated by wedge resection: A case report
Fahrettin Acar, Mustafa Sahin, Serdar Ugras, Akın Calisir
Fahrettin Acar, Mustafa Sahin, Akın Calisir, Department of General Surgery, Faculty of Medicine, Selcuk University Konya, Konya 42075, Turkey
Serdar Ugras, Department of Pathology, Faculty of Medicine, Selcuk University Konya, Konya 42075, Turkey
Author contributions: All authors contributed equally to this case report.
Correspondence to: Fahrettin Acar, MD, Assistant Professor, Department of General Surgery, Faculty of Medicine, Selcuk University Konya, Campus of Alaaddin Keykubat, Selcuklu, Konya 42075, Turkey. drfacar@hotmail.com
Telephone: +90-332-2415000 Fax: +90-332-2415000
Received: July 30, 2013
Revised: October 19, 2013
Accepted: November 18, 2013
Published online: December 27, 2013
Processing time: 149 Days and 7.6 Hours
Abstract

A 65-year old woman was admitted to our hospital with abdominal pain. Computed tomography showed a tumor measuring about 3 cm in diameter with no metastatic lesion or signs of local infiltration. Gastroduodenal endoscopy revealed the presence of a submucosal tumor in the third portion of the duodenum and biopsy revealed tumor cells stained positive for c-kit. These findings were consistent with gastrointestinal stromal tumors (GISTs) and we performed a wedge resection of the duodenum, sparing the pancreas. The postoperative course was uneventful and she was discharged on day 6. Surgical margins were negative. Histology revealed a GIST with a diameter of 3.2 cm and < 5 mitoses/50 high power fields, indicating a low risk of malignancy. Therefore, adjuvant therapy with imatinib was not initiated. Wedge resection with primary closure is a surgical procedure that can be used to treat low malignant potential neoplasms of the duodenum and avoid extensive surgery, with significant morbidity and possible mortality, such as pancreatoduodenectomy.

Keywords: Gastrointestinal stromal tumor, Duodenum, Wedge resection, Surgery

Core tip: Duodenal gastrointestinal stromal tumors (GISTs) are uncommon, with a relatively small subset of GISTs whose optimal surgical procedure has not been well defined. Because submucosal spread and local lymph node involvement is infrequent in GISTs, wide margins with routine lymph node dissection may not be required. Various techniques of limited resection for duodenal GISTs have been described, depending on the site and the size of the tumors. Herein, we present a case of GIST involving the third portion of the duodenum successfully treated by wedge resection with primary closure.