부산대학교 도서관

A 76-year-old man suffering from continuous vomiting was referred to our hospital. Abdominal mass was palpable, and CT scan showed a huge abdominal cystiform tumor (20cm in diameter) and a whirl sign of the jejunum accompanied by a dilation of the oral side intestine. The tumor had papillary nodules inside of the cystic wall, while FDG-PET showed no FDG accumulation in the nodules. Meanwhile, FDG accumulated in the transverse colon liver flexure abnormally, suggesting coincidence of colon cancer. We diagnosed him as a case of volvulus of the small intestine induced by the small intestininal tumor, and performed an elective surgery. A huge cystiform tumor was located in the jejunum at about 10 cm from the ligament of Treitz, and the tumor had caused rotation of the jejunum at 180°, with the mesenteric vessels as the rotational axis. We underwent a partial resection of the jejunum including the tumor. Additionally, we performed colectomy with D3 lymph node dissection for the coexisted transverse colon cancer. Histopathologically, the cystiform tumor was diagnosed as GIST, which was positive for c-kit. Our case is the ninth reported in Japan as GIST of jejunum with small intestinal volvulus.