Acute abdomen caused by nontraumatic hemoperitoneum is the first manifestation of gastric low grade stromal tumor

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract in adults. We treated surgically a man with acute abdomen caused by non-traumatic hemoperitoneum and diagnosed by low grade gastric GIST. METHODS: A 51-year-old Caucasian man came to the hospital for abdominal pain for 3 hours. He had no history of abdominal trauma. On admission, he was conscious and alert, and he had hypotension (80/50 mmHg) and moderate tachycardia. Abdominal ultrasonography showed the presence of free peritoneal fluid. Abdominal magnetic resonance imaging (MRI) showed diffuse intraabdominal hemorrhage and solid mass lesion at the greater curvature of the stomach. At an emergency laparotomy, a pedunculated, fragile mass of 5x6 cm originating from the posterior wall of the stomach was seen. The tumor was resected. Histopathologically a gastrointestinal stromal tumor was detected. RESULTS: The patient had an uneventful postoperative course and was discharged on the sixth postoperative day. Follow-up showed no recurrence of the tumor 8 months after surgery. CONCLUSION: Intraabdominal bleeding is a rare presentation of gastrointestinal stromal tumors. The diagnosis of the tumor should be based on whether sudden abdominal pain occurs in patients with an intraabdominal mass.