We present the case of a 54-year-old male patient, with a history of gastric ulcer due to H. Pylori more than 10 years ago and no other past medical history. The patient presented with hematochezia and significant fatigue in the last 24 hours in the emergency room with a hypovolemic shock.
An emergency endoscopy showed a 2-cm lesion on the greater curvature, with a macroscopically normal mucosa and no ulceration, but a pounding blood vessel. Hemostasis was achieved with clips. The CT scan revealed a 25 mm solid tumor in the greater curvature, suggesting GIST.
The patient stabilized in the ICU although he had a new bleeding episode, which was treated again endoscopically with sclerotherapy, but definitive surgical intervention was then proposed.
The patient was placed in the supine position with open legs. A total of four trocars were used. Adhesions were freed between the stomach, omentum and abdominal wall. Dissection had to be careful to avoid opening the tumor. Ligasure was used to complete the dissection and good hemostasis
Subsequently, it was necessary to delimit the size of the tumor, controlling it both proximally and distally by means of sutures. The surgeon corroborates that the proximal stomach is completely free from adhesions, which allows proper manipulation during the section of the gastric wall.
An orogastric tube – such as a Foucher tube – must be introduced to calibrate the wedge resection, preserve a sufficient gastric lumen, and ensure neoplasia-free margins.
After delimiting the limits of the tumor, the Endo GIA stapler is introduced for wedge resection, starting distally and continuing proximally in order to complete the tumor resection. It is important to check anteriorly and posteriorly before firing the mechanical suture as well as check the staple line and confirm hemostasis.
Operative time was 95 minutes. The patient started oral intake the next day after the surgery and left hospital on the 3rd postoperative day with no complications. The final pathology was described as a 3 cm tumor located in the submucosa, with free margins and Ki67 proliferative activity in less than 2% of the cells, compatible with GIST.