1916 Gastrointestinal Stromal Tumor: Cause of Massive Lower Gastrointestinal Bleed in Young Patient

Abstract

INTRODUCTION: Gastrointestinal stromal tumor (GIST) is one of the rare causes of gastrointestinal malignancies. GIST most commonly occurs in stomach. It arises from one of the specialized cells of GI tract, called as Interstitial Cells of Cajal (ICC) and mutations in one of the KIT gene or PDGFRA are responsible for the development of this tumor. We are here presenting a case of massive GI bleed in a very young patient from GIST tumor in small intestine. CASE DESCRIPTION/METHODS: 26-year-old male presented to ED complaining of having 3–4 bloody bowel movements in the last 2 days. He stated having soft stool mixed with a large amount of bright red blood. Patient denied abdominal pain, nausea, vomiting, recent travel, sick contacts or weight loss. Patient had low systolic blood pressure in the range of 70–80 on admission. Blood pressure was stabilized with IV fluids. Patient dropped hemoglobin during hospitalization to 5.8 and was transfused 7 PRBC’s. CT abdomen w/contrast revealed a circumferential, lobulated proximal ileal small bowel mass measuring 2.3 × 2.2 × 2.9 cm. EGD and Colonoscopy were done initially which showed extensive amount of blood and clots throughout the colon with very limited views of underlying mucosa but terminal ileum was normal in appearance. No active bleeding was noted. General surgery was consulted and resection of the tumor, that appeared to be the source of the bleeding, was performed in the mid ileum. A 5 cm resection of segment of small bowel was done. Pathology report showed GIST tumor. Patient bleeding stopped subsequently after surgery. DISCUSSION: GIST most commonly arises in fifth and sixth decades of life. It may be familial or sporadic. Mutations of KIT (80 %) and PDGFRA (10 %) are associated with both familial and sporadic causes. GIST tumors majority of the time are incidental findings but when symptomatic presenting complaints may include abdominal pain and swelling, nausea, vomiting, loss of appetite, or weight loss. Patient may also present with bowel perforation, acute abdomen and peritonitis. Rarely, they present with GI blood loss resulting in symptomatic anemia and hemodynamic instability. Almost 30% of the GIST tumors are malignant with the histological findings including highly cellular spindle cells or epitheloid mesenchymal tumors. The diagnosis is confirmed by immunohistochemical techniques and expression of tyrosine kinase receptor. Treatment for resectable tumors is surgery while those of non-resectable tumors is Imatinib a tyrosine kinase inhibitor.