Jejunal gastrointestinal stromal tumour: a rare cause of severe small bowel bleeding

Gastrointestinal stromal tumours (GIST) are rare neoplasms arising from the interstitial cells of Cajal [1]. The prevalence of GIST is reported to be 0.70 per 100,000 individuals per year, and up to 30% of cases demonstrate malignant potential [2]. The jejunum is a rare location for these neoplasms and, in comparison to gastric GISTs, is considered to have a less favourable prognosis [3]. Generally, small bowel bleeding is the cause of 5–10% of gastrointestinal bleeds and is often a diagnostic challenge for GI practitioners. We present a case of a jejunal GIST manifested as recurrent gastrointestinal bleeding, and an overview of an evidence-based, small bowel bleeding diagnostic strategy.
A 65-year-old male was admitted to our hospital for further investigation of recurrent, massive melena, which he had experienced twice in the previous 6 months. In both of those previous episodes, he reported painless, dark-coloured stool following a syncopal episode with a haemoglobin decrease to 7 g/dl requiring a blood transfusion. The patient had undergone outpatient esophagogastroduodenoscopy (EGD) and colonoscopy twice, which failed to identify the source of bleeding. Therefore, he was admitted to our department for further evaluation. The patient denied any history of nonsteroidal anti-inflammatory drug use, peptic ulcer, or chronic liver disease. The patient’s comorbidities included hypertension, laparoscopic cholecystectomy 7 years prior due to cholelithiasis, and subsequent hepaticojejunostomy due to choledocholithiasis 3 months later. The physical examination upon admission was unremarkable. Laboratory analysis showed microcytic anaemia (Hgb 9.2 g/dl, MCV 77 fl, Fe 6 µmol/l), while other biochemical parameters were within normal limits. Transabdominal ultrasound and chest X-ray were unremarkable.
EGD and colonoscopy performed within the first 24 h of patient presentation were both negative. There was no recurrent GI bleeding during the hospitalization. Repeat EGD also showed no abnormalities except for Helicobacter pylori-negative gastritis. Repeat colonoscopy with terminal ileoscopy revealed multiple (up to 10) small arterio-venous malformations in the left colon without signs of bleeding. After assuming the bleeding originated from the small bowel, we performed multi-slice computed tomography (CT) angiography, which identified a 3 cm × 3 cm small bowel tumour mass with a vascular supply originating from the superior mesenteric artery...


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