Abstract
BackgroundMassive intraluminal bleeding requires urgent intervention and management. However, the source of bleeding on the small intestine is difficult to determine. Intestinal tumor with intussusception is a rare and normally not an urgent condition. Herein, we present a rare case of intestinal intussusception with massive bleeding due to jejunal gastrointestinal stromal tumor (GIST) that required emergency surgical treatment.Case presentationA 51-year-old male was admitted to the emergency department complaining of abdominal pain and acute hematochezia. Esophagogastroduodenoscopy (EGD) and colonoscopy could not determine the source of the bleeding site. Abdominal pelvic computed tomography (AP-CT) revealed GIST with intussusception, strongly suggestive of distal jejunal bleeding. Unresponsive transfusion with low blood pressure and continuous hematochezia led to emergency laparotomy. GIST, which was the leading point for intussusception, was located in the jejunum and showed mucosal ulceration of approximately 3.5 cm in diameter. Following resection and functional anastomosis, histology revealed a GIST with low mitotic count (< 5 per 50HPF). Moreover, immunochemical analysis revealed positivity for c-kit (CD117) and DOG-1. There were no complications 2 months after surgery.ConclusionsIntussusception associated with GIST is a rare finding that can be life-threatening if it occurs with an ulcer. This case showed that the early detection of bleeding and emergency surgery could prevent severe complications.
Highlights
Massive intraluminal bleeding requires urgent intervention and management
Intussusception associated with gastrointestinal stromal tumor (GIST) is a rare finding that can be life-threatening if it occurs with an ulcer
A review of 18 cases of intussusception secondary to GIST found that approximately 39% (7/18) of GISTs were within the small bowel
Summary
Massive hematochezia with melena is a fatal condition that requires an emergent intervention and possibly surgery. The origin of hematochezia is bleeding of the colorectum, small bowel, or stomach. Bleeding of the small bowel is difficult to find and is most likely to be confirmed late [1]. Small bowel intussusception from GIST in adults has been described in a few cases in the literature. Case presentation A 51-year-old male patient was admitted to the emergency department with massive hematochezia, hypotension, and abdominal pain. The patient reported intermittent hematochezia for 3 days. His medical history was remarkable for hypertension only. Because of unresponsive transfusion for low blood pressure and continuous hematochezia, an emergency laparotomy was performed. Hypercellular and hypocellular areas were identified with mostly hypercellular component showing nodular appearance under low magnification. DOG1 ( known as ANO1, anoctamin 1) stain was positive in our case, which is sensitive and relatively specific for GIST, confirming the diagnosis
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