Digestive bleeding due to jejunal stromal tumor: A train can hide another-A case report.

Gastrointestinal mesenchymal tumors (GIST) are the most prevalent sarcoma tumors affecting the digestive tract. GIST originates from Cajal cells located within the digestive tract's wall. These cells play a crucial role in regulating digestive peristaltism as they are considered pacemaker cells. These tumors are especially located in the stomach (60%) but can also be seen in the small bowel (30%), in which jejunal stromal tumors are estimated to reach (40%). In this case report, we describe a jejunal GIST, which was initially discovered due to active bleeding, serving as the primary symptom, along with an underlying small loop intussusception. In our knowledge, GIST causing an intussusception is a rare entity in literature as well as GIST causing active bleeding. For that aim, we present a 36-year-old male patient, presented to our department with melena. An abdominal computed tomography scan was performed, revealing a small bowel intussusception associated with a 2 cm tumor. Despite the imprecise cause of the bleeding, due to the ongoing active hemorrhage, we decided to proceed with an emergency laparotomy, suspecting a tumorous origin of the bleeding. During the surgery, the tumor was located in the jejunum. The affected jejunal segment containing the tumor was resected, and an anastomosis was performed. Pathology examination confirmed a stromal tumor. The postoperative follow-up was uneventful.

Is there a route for metachronous inguinal lymph node in colonic cancer? A case report.

As the inguinal lymph nodes do not serve as the primary route for the lymphatic drainage of the colon, inguinal metastasis from colorectal carcinomas is considered an unusual finding, especially in the 2nd year follow-up. A 76-year-old male patient, operated on for non-metastatic right colic adenocarcinoma, consulted 2 years after for a right inguinal swelling. A biopsy was performed. Unexpectedly, it showed an adenocarcinoma metastasis in favor of a colonic origin. There was no relapse of the disease. The pathological examination of the resected inguinal lymph node confirmed malignant cells from a colonic origin. As the positron emission tomography scan showed no other tumoral localizations, a multidisciplinary discussion ensued, culminating in the choice of chemotherapy for optimal pathological response. This case highlights the fact that colic drainage may encounter inguinal lymph nodes and thus inguinal groin metastasis could exceptionally have been seen in colonic carcinomas.