GASTROINTESTINAL BLEEDING CAUSED BY JEJUNAL GIST

Case Presentation F.P.B, a 66-year-old male, was admitted to the emergency department with a two-week history of melena. On physical examination, significant cutaneous pallor was observed. A complete blood count revealed a hemoglobin level of 6.9 g/dl. An urgent upper gastrointestinal endoscopy was performed, which did not show signs of active bleeding. Abdominal angiography (CT angiography) revealed circumferential wall thickening of a jejunal loop near the left flank, adjacent to the descending colon, with irregular contours, calcification foci, and slight contrast enhancement, suggesting a primary neoplasm. A surgical approach was undertaken, involving enterectomy and enteroanastomosis. From admission to surgery, the patient received 7 units of red blood cell concentrates. Pathological examination of the enterectomy specimen revealed a gastrointestinal stromal tumor (GIST) with a mixed histological pattern. Immunohistochemical studies for diagnostic confirmation showed positive CD-117 expression in the cells of interest, supporting the diagnosis of GIST.

Discussion GISTs are rare neoplasms, accounting for approximately 1-2% of primary gastrointestinal cancers. Their estimated incidence is 10 to 20 cases per million people. The most common site of occurrence is the stomach (40-60%), followed by the jejunum/ileum (25-30%). The most common presentation of GIST is gastrointestinal bleeding, as seen in this case. Therefore, the manifestations of the disease are closely related to the tumor's location. Upper gastrointestinal tract involvement is typically accompanied by melena or dysphagia, while lower gastrointestinal tract neoplasms may present with constipation or intestinal obstruction. Regarding the risk of progression of GISTs, factors such as mitotic index, tumor size, and location are considered. In this case, the risk of tumor progression was considered high, with a mitotic index above 5 mitoses/5 mm, a size of 3.6 cm, and jejunal involvement.

Conclusion Although jejunal GISTs are rare and often challenging to diagnose, it is important to maintain a high level of suspicion for the condition, especially in the context of gastrointestinal bleeding combined with suspicious radiological findings. Early detection increases the likelihood of employing surgical treatment, which offers higher cure rates.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025