Perforated gastrointestinal stromal tumor in the small intestine: A rare case of Torricelli-Bernoulli sign

Tajima,Takayuki; Nishi,Takayuki; Tomioku,Mifuji; Ogimi,Takashi; Chan,Lin  Fung; Okazaki,Takashi; Myoujin,Kazunori; Shimada,Hideo

doi:10.3892/mco.2018.1699

Perforated gastrointestinal stromal tumor in the small intestine: A rare case of Torricelli-Bernoulli sign

Authors:
- Takayuki Tajima
- Takayuki Nishi
- Mifuji Tomioku
- Takashi Ogimi
- Lin Fung Chan
- Takashi Okazaki
- Kazunori Myoujin
- Hideo Shimada
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Affiliations: Department of Surgery, Tokai University Oiso Hospital, Kanagawa 259-0189, Japan, Department of Radiology, Tokai University Hospital, Kanagawa 259-1193, Japan, Department of Radiology, Tokai University Oiso Hospital, Kanagawa 259-0189, Japan
Published online on: August 16, 2018 https://doi.org/10.3892/mco.2018.1699
Pages: 399-402

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Abstract

The Torricelli-Bernoulli sign is a computed tomography (CT) finding that occurs when ulceration/necrosis of a submucosal gastrointestinal tumor releases a stream of air bubbles into the intestinal lumen. A 75-year-old man developed acute abdominal pain at night and presented to a local doctor. Acute abdomen was diagnosed and he was referred to the Emergency Department at Tokai University Oiso Hospital. On CT scans, disseminated intestinal tumor-like lesions were seen in the right lower abdomen. The Torricelli-Bernoulli sign and free intraabdominal gas were observed, so perforation of an intestinal tumor was diagnosed and emergency surgery was performed. At operation, there was scanty opaque ascites in the right lower abdomen and an ileal tumor associated with nodules that suggested peritoneal dissemination. Partial resection of the ileum was performed and peritoneal lavage was conducted. The patient was discharged on postoperative day 11. Histopathological examination revealed a high risk gastrointestinal stromal tumor. The abdominal nodules were metastases, indicating that the tumor was Stage IV. The patient is currently on treatment with an oral tyrosine kinase inhibitor (imatinib).

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1	Fortman BJ: Torricelli-Bernoulli sign in an ulcerating gastric leiomyosarcoma. AJR Am J Roentgenol. 173:199–200. 1999. View Article : Google Scholar : PubMed/NCBI
2	Sureka B, Bansal K and Arora A: Torricelli-Bernoulli Sign in gastrointestinal stromal tumor. AJR Am J Roentgenol. 205:W468. 2015. View Article : Google Scholar : PubMed/NCBI
3	Hirota S, Isozaki K, Moriyama Y, Hashimoto K, Nishida T, Ishiguro S, Kawano K, Hanada M, Kurata A, Takeda M, et al: Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science. 279:577–580. 1998. View Article : Google Scholar : PubMed/NCBI
4	Kindblom LG, Remotti HE, Aldenborg F and Meis-Kindblom JM: Gastrointestinal pacemaker cell tumor (GIPACT): Gastrointestinal stromal tumors show phenotypic characteristics of the interstitial cells of Cajal. Am J Pathol. 152:1259–1269. 1998.PubMed/NCBI
5	Miettinen M, Sarlomo-Rikala M and Lasota J: Gastrointestinal stromal tumors: Recent advances in understanding of their biology. Hum Pathol. 30:1213–1220. 1999. View Article : Google Scholar : PubMed/NCBI
6	Graadt van Roggen JF, van Velthuysen MLF and Hogendoorn PCW: The histopathological differential diagnosis of gastrointestinal stromal tumours. J Clin Pathol. 54:96–102. 2001. View Article : Google Scholar : PubMed/NCBI
7	Ludwig DJ and Traverso LW: Gut stromal tumors and their clinical behavior. Am J Surg. 173:390–394. 1997. View Article : Google Scholar : PubMed/NCBI
8	Connolly EM, Gaffney E and Reynolds JV: Gastrointestinal stromal tumours. Br J Surg. 90:1178–1186. 2003. View Article : Google Scholar : PubMed/NCBI
9	Miettinen M and Lasota J: Gastrointestinal stromal tumors-definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Arch. 438:1–12. 2001. View Article : Google Scholar : PubMed/NCBI
10	Ueyama T, Guo KJ, Hashimoto H, Daimaru Y and Enjoji M: A clinicopathologic and immunohistochemical study of gastrointestinal stromal tumors. Cancer. 69:947–955. 1992. View Article : Google Scholar : PubMed/NCBI
11	Baheti AD, Shinagare AB, O'Neill AC, Krajewski KM, Hornick JL, George S, Ramaiya NH and Tirumani SH: MDCT and clinicopathological features of small bowel gastrointestinal stromal tumours in 102 patients: a single institute experience. Br J Radiol. 88:201500852015. View Article : Google Scholar : PubMed/NCBI
12	Efremidou EI, Liratzopoulos N, Papageorgiou MS, Romanidis K, Manolas KJ and Minopoulos GJ: Perforated GIST of the small intestine as a rare cause of acute abdomen: Surgical treatment and adjuvant therapy. Case report. J Gastrointestin Liver Dis. 15:297–299. 2006.PubMed/NCBI
13	Misawa S, Takeda M, Sakamoto H, Kirii Y, Ota H and Takagi H: Spontaneous rupture of a giant gastrointestinal stromal tumor of the jejunum: A case report and literature review. World J Surg Oncol. 12:1532014. View Article : Google Scholar : PubMed/NCBI
14	Shoji M, Yoshimitsu Y, Maeda T, Sakuma H, Nakai M and Ueda H: Perforated gastrointestinal stromal tumor (GIST) in a true jejunal diverticulum in adulthood: Report of a case. Surg Today. 44:2180–2186. 2014. View Article : Google Scholar : PubMed/NCBI
15	Khuri S, Gilshtein H, Darawshy AA, Bahouth H and Kluger Y: Primary small bowel GIST presenting as a life-threatening emergency: A report of two cases. Case Rep Surg. 2017:18142542017.PubMed/NCBI
16	Alessiani M, Gianola M, Rossi S, Perfetti V, Serra P, Zelaschi D, Magnani E and Cobianchi L: Peritonitis secondary to spontaneous perforation of a primary gastrointestinal stromal tumour of the small intestine: A case report and a literature review. Int J Surg Case Rep. 6C:1–62. 2015.PubMed/NCBI
17	Sato K, Tazawa H, Fujisaki S, Fukuhara S, Imaoka K, Hirata Y, Takahashi M, Fukuda S, Kuga Y, Nishida T, et al: Acute diffuse peritonitis due to spontaneous rupture of a primary gastrointestinal stromal tumor of the jejunum: A case report. Int J Surg Case Rep. 39:288–292. 2017. View Article : Google Scholar : PubMed/NCBI
18	Driver R: Toricelli's law: An ideal example of an elementary ODE. Am Math Mon. 105:453–455. 1998. View Article : Google Scholar
19	Stedman TL: Stedman's Medical Dictionary. 25th Edition. Williams & Wkjins; Baltimore: pp. 1821990
20	Nishida T, Kumano S, Sugiura T, Ikushima H, Nishikawa K, Ito T and Matsuda H: Multidetector CT of high-risk patients with occult gastrointestinal stromal tumors. AJR Am J Roentgenol. 180:185–189. 2003. View Article : Google Scholar : PubMed/NCBI
21	Amano M, Okuda T, Amano Y, Tajiri T and Kumazaki T: Magnetic resonance imaging of gastrointestinal stromal tumor in the abdomen and pelvis. Clin Imaging. 30:127–131. 2006. View Article : Google Scholar : PubMed/NCBI
22	Grover S, Ashley SW and Raut CP: Small intestine gastrointestinal stromal tumors. Curr Opin Gastroenterol. 28:113–123. 2012. View Article : Google Scholar : PubMed/NCBI
23	West RB, Corless CL, Chen X, Rubin BP, Subramanian S, Montgomery K, Zhu S, Ball CA, Nielsen TO, Patel R, et al: The novel marker, DOG1, is expressed ubiquitously in gastrointestinal stromal tumors irrespective of KIT or PDGFRA mutation status. Am J Pathol. 165:107–113. 2004. View Article : Google Scholar : PubMed/NCBI
24	DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM and Brennan MF: Two hundred gastrointestinal stromal tumors: Recurrence patterns and prognostic factors for survival. Ann Surg. 231:51–58. 2000. View Article : Google Scholar : PubMed/NCBI
25	Emory TS, Sobin LH, Lukes L, Lee DH and O'Leary TJ: Prognosis of gastrointestinal smooth-muscle (stromal) tumors: Dependence on anatomic site. Am J Surg Pathol. 23:82–87. 1999. View Article : Google Scholar : PubMed/NCBI
26	Demetri GD, von Mehren M, Antonescu CR, Dematteo RP, Ganjoo KN, Maki RG, Pisters PWT, Raut CP, Riedel RF, Schuetze S, Sundar HM, Trent JC and Wayne JD: NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Canc Netw. 8 suppl 2:S1–S41; quiz S42-S44. 2010. View Article : Google Scholar : PubMed/NCBI
27	ESMO/European Sarcoma Network Working Group, . Gastrointestinal stromal tumors: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 23:vii49–vii55. 2012.PubMed/NCBI
28	Demetri GD, von Mehren M, Blanke CD, Van den Abbeele AD, Eisenberg B, Roberts PJ, Heinrich MC, Tuveson DA, Singer S, Janicek M, et al: Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med. 347:472–480. 2002. View Article : Google Scholar : PubMed/NCBI
29	Demetri GD, van Oosterom AT, Garrett CR, Blackstein ME, Shah MH, Verweij J, McArthur G, Judson IR, Heinrich MC, Morgan JA, et al: Efficacy and safety of sunitinib in patients with advanced gastrointestinal stromal tumour after failure of imatinib: A randomised controlled trial. Lancet. 368:1329–1338. 2006. View Article : Google Scholar : PubMed/NCBI
30	Wilhelm SM, Dumas J, Adnane L, Lynch M, Carter CA, Schütz G, Thierauch KH and Zopf D: Regorafenib (BAY 73–4506): A new oral multikinase inhibitor of angiogenic, stromal and oncogenic receptor tyrosine kinases with potent preclinical antitumor activity. Int J Cancer. 129:245–255. 2011. View Article : Google Scholar : PubMed/NCBI
31	Kajiura S, Hosokawa A, Nanjyo S, Nakada N, Ando T and Sugiyama T: A case of a gastrointestinal stromal tumor of the rectum effectively treated with continuously-administered regorafenib after failure of imatinib and sunitinib. Nihon Shokakibyo Gakkai Zasshi. 113:655–661. 2016.(In Japanese). PubMed/NCBI