Spastic S‐shaped sigmoid colon in hemorrhagic GIST

Abstract

We treated a 44‐year‐old man with abdominal pain and melena caused by the gastrointestinal stromal tumor. In this case, computed tomography revealed a spastic S‐shaped sigmoid colon, indicating intestinal spastic paralysis secondary to intestinal bleeding. This finding prompted screening colonoscopy for gastrointestinal bleeding.

Short abstract

An S‐shaped sigmoid colon occationally indidates active intestinal bleeding by any cause. In our case, heamorrhagic intestinal GIST accounted for the S‐shaped sigmoid sign.

We treated a 44‐year‐old man presenting with abdominal pain and melena. He had severe anemia, with a hemoglobin level of 4.3 mg/dl. In the ambulatory unit, the patient suffered a hemorrhagic shock; therefore, he was transfused with a total of 12 units of red blood cells and underwent emergency surgery. Preoperative computed tomography showed a 2.5‐cm intestinal intraluminal polypoid tumor (Figure 1A) and a spastic S‐shaped ¹ sigmoid colon with high intraluminal density (Figure 1B). He underwent partial resection of the intestine. The pathologic diagnosis revealed a gastrointestinal stromal tumor (Figure 1C). In this case, the S‐shaped sigmoid colon indicated intestinal spastic paralysis secondary to intestinal bleeding. The sigmoid colon has a functionally mobile structure that is free from peritoneal fixation and contracts to send stool to the rectum. Therefore, an immobile sigmoid colon would be observed as a firm S shape in its original formation. We recommend checking for active intestinal bleeding in cases with an S‐shaped sigmoid colon.

FIGURE 1.

(A) A dynamic computed tomography scan at the onset showed an intestinal intraluminal tumor. The tumor was depicted in high‐density mass with contract enhancement. (B) Simultaneously, a spastic “S”‐shaped sigmoid colon was illustrated with intraluminal high density. (C) The pathological diagnosis of the partially resected intestine revealed a gastrointestinal stromal tumor (GIST). GIST is composed of fairly uniform spindle cells in submucosal lesion (upper panel). The tumor cells displayed dense proliferation of spindle‐type tumor cells with paley eosinophilic and fibrillary cytoplasm (bottom panel).

AUTHOR CONTRIBUTIONS

Makiko Uemura: Conceptualization; project administration; resources; supervision; writing – review and editing.

FUNDING INFORMATION

The authors have no funding source to disclose concerning this report. This work was supported by JSPS KAKENHI Grant Numbers JP19K17927.

CONFLICT OF INTEREST

The authors have no conflicts of interest to disclose.

ETHICAL APPROVAL

We obtained approval from the Kagawa University Hospital Institutional Review Board. This research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. The subject has given their written informed consent to publish their case (including the publication of images). The case report was approved by the institute's committee on human research.

CONSENT

Written informed consent was obtained from the patients for publication of this study.

COMPETING INTERESTS

The authors declare that they have no competing interests.

Imataki O, Uemura M. Spastic S‐shaped sigmoid colon in hemorrhagic GIST. Clin Case Rep. 2022;10:e06668. doi: 10.1002/ccr3.6668

DATA AVAILABILITY STATEMENT

All data generated or analyzed during this study are included in this published article.