Anal Reconstruction in a Rare Case of Perianal Extragastrointestinal Stromal Tumors

ABSTRACT Gastrointestinal stromal tumors (GISTs) are rare (10/15 cases per million worldwide). Anal GIST is still rarer (16 cases reported in journals). Extra-GISTs form only 1% of GISTs. Perianal extragastrointestinal stromal tumors (EGISTs) are uncommon among EGISTs with hardly any reported cases. The authors are presenting a case of recurrent perianal EGIST which was treated by wide local excision leaving a defect involving half of the circumference and full length/thickness of anal canal and anal sphincters anteriorly. As against the common practice of reconstruction with dynamic muscle transfer, usually gracilis or gluteus, the defect was repaired with levatoroplasty and Limberg skin flaps. Anal sphincter remnants were pulled and opposed esp. at the cephalic end or anchored onto the levators. The patient achieved full anal continence in a year. The authors would like to suggest it as a method of choice for anal GIST and perianal EGIST.