CASE 267:PELVIC MASS and MELENA, Dr PHAN THANH HẢI, Dr LÊ ĐÌNH TÍN, Dr LÊ ĐÌNH VĨNH PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man  37 yo in urgency by melena and  hypotension.

Ultrasound of  abdomen first detected  one 6cm mass  at  the pelvis, well bordered  (US image 1: mass  near  the  urinary  bladder  wall, US 2: very hypoechoic with linear probe 12MHz, US 3 elasto: this mas soft and inhomogeneous, and video hypervascular mass).

MSCT with CE of this mass showed rapid and high CE enhancement (see 3 CT images).

There were no relation between the mass with GI tract lumen.
 Blood test  Hct  20%  post blood transfusion.  And gastroscopy and colonoscopy: NAD (nothing abnormal detected).
Today, laparotomy found out the mass in the small bowel wall, with vascular congestion. And there was one site eroding the mucosa layer of intestine. Maybe bleeding from this site (see operation images).

Discussion:

Ultrasound first  presented best application for this emergency case. First, sonologist detected one cystic mass at the right pelvis, with linear probe 12 MHz;  but in using of curve  probe 3.5MHz showing a solid  mass in appearance and hypervascular mass on Doppler. Elastoscan also said this mass being a  soft mass. MSCT with CE reported this mass in fast and high contrast enhancement. At the mesenteric border no  bleeding site detected at this time, suggesting a GIST tumor in case of GI tract bleeding. Endoscopy of GI tract was complementary tool for negative detection.
Operation was set on time.

Microscopy  report with IHS is small bowel GIST.