Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors primarily located in the stomach and small intestine; their occurrence in the terminal ileum is particularly rare. Although GISTs can develop throughout the gastrointestinal tract, cases of perforation in elderly individuals are even less common, posing significant diagnostic and therapeutic challenges. This case report describes an 86-year-old male patient with an acute abdomen caused by a terminal ileum perforated GIST requiring urgent surgical intervention. An immunohistochemical examination of the tumor confirmed a GIST with a GILT (gastrointestinal leiomyogenic tumor) immunophenotype. The rarity of this condition makes it diagnostically challenging, as its symptoms are often nonspecific, and GISTs are frequently overlooked, particularly in older patients. This case supplements the existing literature by emphasizing the importance of considering GIST perforation in the differential diagnosis of an acute abdomen, even in elderly patients and in rare anatomical locations.

Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors, primarily located in stomach and small intestine, while occurrence in the terminal ileum is particularly rare. Although GISTs can develop throughout the gastrointestinal tract, cases of perforation in elderly individuals are even less common, posing significant diagnostic and therapeutic challenges. This case report describes a 86-year-old male patient with an acute abdomen caused by a terminal ileum perforated GIST requiring urgent surgical intervention. Immunohistochemical examination of the tumor confirmed GIST with a GILT (gastrointestinal leiomyogenic tumor) immunophenotype. The rarity of this condition makes it diagnostically challenging, as symptoms are often nonspecific, and GISTs are frequently overlooked, particularly in older patients. This case underscores the importance of diagnostic features of this tumor and consideration of a wide differential diagnosis when assessing elderly patients presenting with suspected gastrointestinal perforation.

Background: Cystobiliary communication (CBC) is the most common complication of liver hydatid disease (LHD). This study aimed to analyze operative management and outcomes in surgically treated patients and identify predictors of CBC. Methods: A prospectively maintained single-center database (January 1963–June 2025), consisting of 1507 consecutive patients who underwent surgery for LHD, was retrospectively analyzed. Patients were divided into two groups based on whether they had CBC. Multivariate logistic regression was used to identify independent predictors of CBC. Results: CBC was identified in 309 patients, corresponding to a prevalence of 20.5% within the study cohort. The patients in the CBC group were younger than those in the non-CBC group (median age: 44 vs. 47 years; P = 0.003) and had larger cysts (10 vs. 8 cm; P < 0.001). Jaundice, cholangitis, fever ( P < 0.001), and leukocytosis ( P < 0.01) were more frequent in the patients with CBC. Conservative surgery (partial pericystectomy) was performed in most patients with LHD (CBC/non-CBC: 85% vs. 90%; P = 0.067). The multivariate analysis identified several predictors of CBC: younger age [odds ratio (OR) = 0.985 per year; 95% confidence interval (CI): 0.977–0.995; P = 0.002], larger cyst diameter (OR = 1.071 per cm; 95% CI: 1.029–1.114; P < 0.001), fever (OR = 1.56; 95% CI: 1.05–2.33; P = 0.029), jaundice (OR = 2.01; 95% CI: 1.12–3.60; P = 0.019), leukocytosis (OR = 1.48; 95% CI: 1.10–1.99; P = 0.010), and contralateral lobe hypertrophy (OR = 1.51; 95% CI: 1.02–2.22; P = 0.038). Conclusion: Conservative surgery was the operative modality for most patients. Beyond the established predictors for CBC, fever, jaundice, leukocytosis, and contralateral lobe hypertrophy emerged as independent risk factors.