부산대학교 도서관

Unexpected massive bleeding following a transanal incisional biopsy for a rectal gastrointestinal stromal tumor in an 82 year old man is reported. This patient presented to the hospital with a 1 month history of intermittent bloody stool. A colonoscope was inserted to the cecum and disclosed a huge submucosal tumor of the rectum with several scattered mucosal ulcers. A transanal incisional biopsy was performed to determine the diagnosis of this unknown mass. Serious hemorrhage with gushing out of part of the tumor through the small incisional wound over the anorectal junction occurred. A salvage abdominal perineal resection was performed 6 hours after the initial surgery due to continued bleeding which caused an unstable hemodynamic condition. Microscopically the tumor was revealed to be a gastrointestinal stromal tumor. The patient died of pneumonia 2 weeks later. The case presented shows that uncontrollable bleeding is possible after a transanal incisional biopsy for a huge rectal gastrointestinal stromal tumor. Based on this latent complication, a transanal incisional biopsy for making a tissue diagnosis is not recommended because the upper border of an extrarectal mass is not accessible during the procedure. Total gross excision of the tumor after a complete preoperative study is the treatment of choice.