gastrointestinal stromal tumours ( gists ) are rare tumours of the gi tract , making up 0.21% of gastrointestinal malignancies .
first identified by mazur and clark in 1983 , these mesenchymal tumours can occur anywhere along the gastrointestinal tract [ 1 , 3 ] . relative rarity combined with non - specific presentation results in delayed diagnosis [ 4 , 5 ] .
we present the first case of gist leading to intussusception at the jejuno - ileal junction in an otherwise well patient prior to presentation .
a 47-year - old female presented as an emergency with severe abdominal pain and profuse vomiting .
she had been experiencing symptoms of intermittent vague abdominal pain associated with weight loss over 6 months , but no change in bowel habit .
pyrexial and abdominal examination revealed distended abdomen with localized tenderness in the left iliac fossa .
blood tests revealed an elevated white cell count ( 18.8 ) , c - reactive protein ( 25 ) , microcytic anaemia ( hb 108 ) and a mildly raised lactate ( 2.37 ) . she was commenced on intravenous fluids .
an abdominal plain film showed prominent bowel loops and ultrasound of the abdomen revealed numerous loops of a distended , fluid filled , non - peristalsing bowel .
there was some evidence of bowel wall thickening , but no clear source of obstruction was identified .
a ct scan was performed showing mesenteric vascular gas and a target sign , virtually pathognomonic of intussuception [ 5 , 6 ] ( figs  1 and 2 ) . 

the patient underwent a laparotomy , which revealed small bowel obstruction with evidence of impending perforation .
a pedunculated polypoid lesion at the jejuno - ileal junction was identified as the lead point for intussusception .
the intussuscepted segment of small bowel was resected and end - to - end primary anastomosis formed .
histological findings were in keeping with a 75-mm gist , jejuno - ileal in origin , with a mitotic count of < 5/mm and a moderate ( 24% ) risk of recurrence .
the tumour was positive for cd117 and carried a c - kit mutation with a deletion in exon 11 .
intussusception is the telescoping of a proximal loop of bowel and its mesentery ( intussusceptum ) into the lumen of bowel distal to it ( intussuscipiens ) .
the phenomenon is rare in adults and presents with non - specific symptoms , such as recurrent abdominal pain , nausea and vomiting . up to 90% of adult cases
have a defined lesion acting as the lead point , which is malignant in overhalf of cases [ 1 , 6 ] .
while correct diagnosis is based on operative findings , suspicion may be raised following imaging techniques .
ct with both oral and intravenous contrast is now widely recognized as the most accurate diagnostic tool ( 58100% accuracy in a recent case series ) [ 1 , 4 ] .
alternating hyper- and hypodense layers of the bowel wall of the intussuscepted segment give rise to a classical 
gists are rare tumours demonstrating a broad spectrum of invasiveness [ 5 , 7 ] and unpredictable behaviour , with recent suggestion that these tumours should no longer be classified as benign or otherwise .
classically gists grow exophytically , into the peritoneal cavity or adjacent organs , further decreasing their likelihood of causing an intussusception . rarely , however
, gists can grow as a pedunculated polyp , as in our case , which may go on to act as a lead point for an intussusception .
their growth pattern leads to a range of non - specific symptoms ( much like an intussusception ) , meaning gists often remain unnoticed until advanced enough to cause complications such as ulceration , obstruction or gi bleed .
gists originate from a malignant transformation of the interstitial cells of cajal [ 1 , 3 ] . 95% of cases show a mutation in the kit proto - oncogene , setting them apart from leiomyomas , leiomyosarcomas and schwannomas of the small intestine . furthermore , near universal expression of cd117a product of the kit proto - oncogene which makes up part of the kit transmembrane receptor tyrosine kinase  is found . again
following the relatively recent discovery of this immunohistochemical profile , management of gists has been transformed .
imatinib , a targeted tyrosine kinase inhibitor , has revolutionized treatment since its introduction in 2001 .
universal guidelines for its use are not currently available ; however , it has a clear role in both adjuvant therapy and neoadjuvant therapy for unresectable or borderline resectable tumours [ 1 , 3 , 9 , 10 ] .
prior to the introduction of imatinib , surgery was the only treatment available and to this day offers the only chance of cure .
surgery is offered for all tumours over 2 cm in diameter , along with a role in debulking or symptomatic relief .
below 2 cm the natural history of these rare tumours is relatively unknown ; therefore , treatment planning is difficult .
given the rarity of spread to lymph nodes , regional lymphadenectomy has not been found to be useful .
intussusception is a rare finding in adults , even more so when occurring secondary to a gastrointestinal stromal tumour .
we present the first case of a jejuno - ileal intussusception secondary to a gist in an otherwise well patient .
diagnosis can be difficult given the non - specific nature of the symptoms , and while different imaging modalities may be useful in evaluating these patients , a firm diagnosis can not be made until histological analysis .
curative treatment can only be offered by surgery ; however , imatinib has a role in both adjuvant and neoadjuvant treatment .
 gastrointestinal stromal tumours ( gists ) are rare tumours , making up 0.21% of gastrointestinal malignancies [ zakaria and daradkeh ( jejunojejunal intussusception induced by a gastrointestinal stromal tumour . 
 case rep surg 2012;2022:173680 ) ] . 
 their relative rarity combined with non - specific presentation results in tumours often remaining undiagnosed until surgery or histological examination [ martis et al . 
 ( a rare case of jejunojejunal intussusception in an adult . 
 indian j surg 2013;75(suppl 1):1820 ) ] . 
 presentation as a lead point for intussusception is particularly rare . 
 we present the first case of gist leading to intussusception at the jejuno - ileal junction in an otherwise well patient prior to presentation . 
 provisional diagnosis was made during emergency laparotomy , and confirmed through histological analysis . 
 a typical immunohistochemical profile was identified , after which the patient was commenced on adjuvant imatinib therapy . 
 we discuss classical presentation of intussusception and gist . 
 further considerations of the investigation and treatment options of gists are also presented . 