Hitting the target: An uncommon case of Obscure-Overt Gastrointestinal Bleeding caused by a Jejunal Gastrointestinal Stromal tumor.
- Author:
Carlos Paolo D. Francisco
1
;
Jonard T. Co
1
Author Information
- Publication Type:Case Reports
- From: Journal of the Philippine Medical Association 2023;101(2):11-14
- CountryPhilippines
- Language:English
-
Abstract:
SIGNIFICANCE:GIST are mesenchymal tumors of the Giltract,
representing less than 1% of Gl neoplasms. GIST arising
from the jejunum is extremely rare and accounts for
0.1%-0.3% of all Gl tumors. Symptoms are non-specific
and relate to the tumor location and size. Large tumors
have wide range of manifestations including nausea,
vomiting, abdominal pain and bleeding. Gl bleeding from
GISTs are mostly obscure in origin and has always been
a diagnostic and therapeutic challenge. We report an
uncommon case of obscure-overt Gl bleeding from a
jejunal GIST. We aim to highlight the advantage of push
enteroscopy and CT angiography (CTA) in the approach
to patients presenting with obscure-overt Gl bleeding.
CLINICAL PRESENTATION:A 72-year-old female presented with sudden episode of massive hematochezia associated with lightheadedness and anemia.
MANAGEMENT:Esophagogastroduodenoscopy and colonoscopy was unremarkable. Push antegrade enteroscopy using a pediatric colonoscope showed an ulcer with a spurting blood vessel in the proximal jejunum. Endoscopic clips were deployed resulting to complete hemostasis. CTA showed a heterogeneously enhancing jejunal mass with prominent vessels. Embolization using polyvinyl alcohol embolic particles was performed. Post-embolization contrast showed complete revascularization of the tumor. She underwent exploratory laparotomy with segmental jejunal resection. Final histopathology diagnosis is CD117 positive, DOG1 positive, spindle cell- type GIST.
RECOMMENDATION:Jejunal GIST presenting as obscure-overt gastrointestinal bleeding is extremely rare. Normal findings from an upper and lower endoscopy in a patient presenting with Gl bleeding should raise a suspicion of small intestinal bleed. When a vascular lesion is suspected, abdominal CTA should be performed. This case highlights the importance of a stepwise and multidisciplinary approach in such cases. - Full text:101(2)_2.pdf
