A RARE FORM OF PRESENTATION OF A SMALL INTESTINE GIST IN THE EMERGENCY DEPARTMENT

Gastro-intestinal stromal tumors are a form of mesenchymal tumors most commonly located in the gastro-intestinal tract, as the name suggests. The symptoms that might occur can be abdominal pain or discomfort, early satiety, bloating, jaundice, fatigue, hematemesis or melena. Most of GISTs (>95%) are positive for the KIT protein. Surgery remains the only curative treatment for GIST amenable for resection. High risk tumors can receive adjuvant or neoadjuvant treatment with Imatinib Mesylate, a tyrosin-kinase inhibitor. We present the case of a 59-years old patient that presented with rectal bleeding and abdominal diffuse pain. Blood tests shows leukocytosis and moderate anemia. CT scan describes an expansive, polycyclic process projected at the limit between the mesogastric region and the left flank, in close contact with the small intestine without any clear demarcation line between them and at the superior pole of the tumor, located in an enteral loop, a band of hyperdensity with net contour. Intraoperative, an extraluminal jejunal tumor was found, located at 15 cm from the duodeno-jejunal flexure, with intraluminal active bleeding, which lead us to suspect a GIST based on the macroscopic aspect. We performed segmental enterectomy of 10 cm of the small intestine containing the tumor with entero-enteral anastomosis end to end. The histopathological and immunohistochemistry examinations correlated with the macroscopic aspect have confirmed the diagnosis of GIST.

154 Evaluating the effects of prophylactic antibiotics on intestinal health in pigs given a corticotropin-releasing factor antagonist during weaning and transport

Prophylactic antibiotics improve intestinal health in pigs; however, it is unknown whether their efficacy interacts with a pig’s stress response following weaning and transport. The study objective was to determine whether a corticotropin-releasing factor (CRF) antagonist would impact the efficacy of prophylactic antibiotics on improving intestinal health in transported weaned pigs. Mixed-sex pigs (n = 56; 5.70 ± 1.05 kg BW) were weaned (20.49 ± 0.64 d), a blood sample was taken, pigs were given an i.p. injection of saline (SAL) or a CRF antagonist (CRFA; 30 µg/kg BW; Astressin B), and then were transported for 12 h. Pigs were given a second and third i.p. injection at 6 and 12 h of transport, respectively. Following transport, 4 SAL and 4 CRFA pigs were blood sampled and euthanized. The remaining 48 pigs were individually housed and assigned to an antibiotic [A; chlortetracycline (441 ppm) + tiamulin (38.6 ppm)] or no antibiotic (NA) diet treatment balanced by injection treatment (n = 12 pigs/treatment combination). Blood was collected at 12 h and on d 3, 7, and 14 and pigs were euthanized on d 7 (n = 24) and d 14 (n = 24) post-weaning and transport. Plasma adrenocorticotropic hormone was reduced overall (P = 0.05; 9.1%) in CRFA versus SAL pigs. On d 7, jejunal villus height was greater (P = 0.04; 33%) in A versus NA pigs. Jejunal zonula occludens-1 (58.8%) and ileal claudin-1 (100.5%) mRNA abundance tended to be increased (P = 0.09) in CRFA+NA versus SAL+NA pigs on d 7. On d 14, jejunal tumor necrosis factor-alpha mRNA abundance was reduced (P = 0.02; 29.9%) in A versus NA pigs and jejunal glucagon-like peptide-2 mRNA abundance was increased (P = 0.03) in CRFA+NA versus SAL+NA (48.4%) and SAL+A versus SAL+NA (55.8%) pigs. No intestinal health parameter differences were detected (P > 0.05) between CRFA+NA and SAL+A pigs. In conclusion, CRFA and A impacted weaned pig intestinal health measures at similar levels.

Isolated myeloid sarcoma presenting with small bowel obstruction: a case report

Background Myeloid sarcoma (MS) is a solid tumor consisting of myeloid blasts or immature myeloid cells, which are unusual outside the bone marrow. Case presentation We present a rare case of isolated myeloid sarcoma of the small bowel in a 54-year-old man who was admitted to our hospital with repeated symptoms of intestinal obstruction. A small bowel series via an ileus tube revealed severe jejunal obstruction. Computed tomography revealed that the obstruction was likely caused by a jejunal tumor. The patient underwent laparoscopy-assisted partial resection of the jejunum with lymphadenectomy. Histopathological examination of the surgical specimen confirmed that MS had been responsible for the obstruction. Conclusions Patients with MS require systemic chemotherapy, as do patients with acute myeloid leukemia. Hence, an early, accurate diagnosis is imperative for treating this malignancy. It is also important to list MS in the differential diagnosis of a small bowel tumor, even in nonleukemic patients.