RESUMO
BACKGROUND: Gastrointestinal stromal tumours (GIST) are histologically heterogenous group of mesenchymal tumours arising in gastrointestinal tract (GIT), though they represent only 0.2% of all GI tumours. The advent of effective chemotherapy for GIST has altered but not diminished the role of surgery which remains the standard therapy for all resectable non-metastatic tumours. PURPOSE: To present our experience of management of GIST which are most common sarcomas of the GIT, commonly seen in stomach and small bowel. METHODS: All cases of GIST managed at our centre from April 2006 to June 2008 were included in the study. RESULTS: Thirteen cases of GIST were operated in the study period. Commonest presenting symptoms were, lump abdomen and dull abdominal pain. After initial USG, CECT was done in all cases. Tumour was seen to arise from small bowel (7/13), stomach (4/13) and one each from oesophagus and omentum. Resection and anastomosis was done in (12/13) cases, one case was inoperable at surgery. Histopathological examination confirmed GIST in all. Immunohistochemistry studies were done in 4/13 cases. 2/13 patients required postoperative chemotherapy. CONCLUSION: GIST has varied presentation as shown by our study. All patients require accurate delineation by CECT scan and individualised management. Immunohistochemistry should be done in all, and those who are in high risk group, metastatic or unresectable require imatinib mesylate. Patients who are CD117 positive show good response to imatinib mesylate. Six monthly follow up is recommended with USG/CECT.
RESUMO
Evaluating and managing patients with abdominal trauma remains one of the most challenging, resource-intensive and satisfying aspects of combat care. It demands a thorough understanding of the pathophysiology of trauma and shock, excellent clinical acumen and the ability to think and operate rationally in a chaotic milieu.
