Pitfalls in the Diagnosis of Obscure Gastrointestinal Bleeding from Gastrointestinal Stromal Tumor of Jejunum; Case report and literature review

Abstract

Background: Gastrointestinal Stromal Tumors (GIST) represent < 1% of Gastrointestinal (GI) neoplasms and jejunal involvement by GIST is very rare. GIST presenting with Obscure Gastrointestinal Bleeding (OGIB) is a rare clinical manifestation. Often these tumors are diagnosed by GI imaging studies, endoscopy, capsule endoscopy or enteroscopy. Case Presentation: We report a case of an elderly male who presented with recurrent episodes of GI bleeding over a period of seven months without a definite diagnosis. Different diagnostic modalities including upper endoscopies, colonoscopies and CT scan of the abdomen without intravenous (IV) contrast have failed to find the source of bleeding. The capsule endoscopy that was done during a phase of active bleeding showed up a lesion in the jejunum, and a push enteroscopy confirmed a tumor in the jejunum. The patient underwent surgical resection of the tumor, and histology was consistent with GIST.  Subsequently, the GI bleeding stopped, and no further recurrences of bleeding happened. Conclusion: We are highlighting the pitfalls of diagnostic modalities in diagnosing obscure GI bleeding and specifically the GIST in the jejunum through this patient’s clinical presentation.