Massive bleeding of a jejunal gastrointestinal stromal tumou
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A jejunal gastrointestinal stromal tumour (GIST) is a rare neoplasm of the gastrointestinal tract. Massive bleeding due to a jejunal GIST is a diagnostic challenge and could present as a life-threatening situation needing urgent intervention. In all, ~20% of GISTs are asymptomatic and are discovered incidentally during abdominal imaging or intraoperatively.

A rare case study published in Journal of Surgical Case Reports of a 54-year-old woman presented with episodes of melaena and haematochezia for the previous 3 days. Other than hypertension she did not have any other comorbidity. On primary physical examination she was pale and had a slight tachycardia but was normotensive.

An oesophagoduodenoscopy was inconclusive. A contrast computed tomography (CT) scan showed a well-defined extraluminal mass in the proximal jejunum suggestive of a bleeding GIST. Her haemodynamic state deteriorated despite initial supportive therapy including a blood transfusion. An urgent laparotomy to excise the jejunal mass was performed.

Histopathology and immunohistochemical studies confirmed the diagnosis. She subsequently received adjuvant imatinib therapy. She has remained symptom free at 5 months post-op.

Conclusion:
Small intestinal GISTs should be considered when managing patients with obscure GI bleeding. Contrast CT scan seems to be an effective tool to diagnose small intestinal bleeding GISTs that are inaccessible by conventional endoscopy.

Source:
https://academic.oup.com/jscr/article/2020/10/rjaa355/5918936
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