Abstract
Introduction. Gastrointestinal stromal tumor (GIST) in the ileum is an extremely rare cause of recurrent lower gastrointestinal bleeding (GIB). Case Report. An 89-year-old man was admitted with melana. He had extensive PMH of CAD post-CABG/AICD, AAA repair, chronic anemia, myelodysplastic syndrome, lung cancer after resection, and recurrent GIB. Prior EGDs, colonoscopies, and upper device-assisted enteroscopy showed duodenal ulcer, A-V malformation s/p cauterization, and angioectasia. On admission, Hb was 6.0 g/dL. An endoscopic capsule study showed an ulcerated tumor in the ileum. CT showed no distant metastasis. The lesion was resected successfully and confirmed as a high-grade GIST. The patient was discharged with no further bleeding. Discussion. Early diagnosis for patients with ileal GIST is often challenging. Video capsule endoscopy and double balloon enteroscopy could be useful diagnostic tools. Surgical removal is the first line for a resectable GIST. Imatinib has become the standard therapy. Conclusion. This is a unique case of an ileal GIST in a patient with recurrent GIB which was diagnosed by video capsule. Complicated medical comorbidities often lead to a significant delay in diagnosis. Therefore, we recommend that if GIB does not resolve after appropriate treatments for known causes, the alternative diagnosis for occult GIB must be considered, including malignancy such as GIST.
Highlights
Gastrointestinal stromal tumor (GIST) in the ileum is an extremely rare cause of recurrent lower gastrointestinal bleeding (GIB)
We present a GIB case of an elderly patient with a GIST arising from the mid of ileum, who had extensive past medical history including coronary artery disease, abdominal aortic aneurysm repair, chronic anemia secondary to myelodysplastic syndrome, lung cancer after resection, gastritis with aspirin use, AV malformation, and superficial duodenal ulcer, which could all be contributing factors for anemia and GIB
Multiple EGDs, colonoscopies, upper device-assisted enteroscopy with fluoroscopy, incomplete capsule endoscopy were performed, which collectively showed gastritis, AV malformation s/p cauterization, nonbleeding superficial duodenal ulcer with a single angioectasia, and numerous small mouthed diverticula in recto-sigmoid colon
Summary
Lower gastrointestinal bleeding (GIB) is the common cause of hospitalization, often involving bleeding from colitis, hemorrhoids, cancer, and vascular anomalies [1]. GISTs are infrequent neoplasms with a reported annual incidence of 6.8 per million in the USA, more commonly occurring in middle-aged and older people with approximately equal sex distribution [2] They are the most common mesenchymal malignancas of the gastrointestinal tract, which were first described by Mazur MT and Clark HB in 1983 [3]. We present a GIB case of an elderly patient with a GIST arising from the mid of ileum, who had extensive past medical history including coronary artery disease, abdominal aortic aneurysm repair, chronic anemia secondary to myelodysplastic syndrome, lung cancer after resection, gastritis with aspirin use, AV malformation, and superficial duodenal ulcer, which could all be contributing factors for anemia and GIB. To the best of our knowledge, no previous case with such extensive medical history has ever been reported
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