S3459 Rare Presentation of Life-Threatening Hematemesis Due to GIST!

Abstract

INTRODUCTION: Severe Upper GI bleed is usually caused by peptic ulcer disease or esophageal varices. Neoplasms, aortoenteric fistulas, and vascular lesions are uncommon etiologies. Patients usually present with hematemesis, melena, or both. Gastrointestinal stromal tumors (GIST) may be asymptomatic and discovered incidentally or may cause nonspecific symptoms like early satiety and fullness. Although GIST may cause upper GI bleed, GIST as a cause of upper GI bleed is very rare. We present a very unique case of massive upper GI bleed due to. CASE DESCRIPTION/METHODS: A 60-year-old male with hypertension and type 2 diabetes, was admitted for two days of melena and massive hematemesis on initial admission. He reported shortness of breath and palpitation, but denied abdominal or chest pain. He denied NSAIDs or blood thinner use. He appeared pale, sweaty with dried blood on his lips. Heart rate was 110 BPM and blood pressure was 90/50 mmHg. Abdomen was soft with no tenderness, rebound, mass lesion, or ascites. Initial laboratory values showed hemoglobin of 5.2 g/dL, leukocytes of 7,200/mm3, platelets of 230,000/mm3, prothrombin time of 12 sec, and INR of 1.05. Chemistry was normal. The patient was promptly resuscitated with a 5 units of packed RBCs, 3 units of FFP, 3 units of platelets, yet his hemoglobin only rose to 6.7. CT for abdomen showed mixed density products seen within the stomach. Upper endoscopy was showed a large amount of fresh blood clots in the gastric body. There was a large ulcerated submucosal gastric mass near the fundus measured 5 × 4.5cm. Biopsy obtained from the margin of the ulcer later showed evidence of GIST. Partial gastrectomy with complete excision of the mass was done. He remained stable in the postoperative period and was discharged home in a stable condition. DISCUSSION: GIST constitute the most common mesenchymal tumors of the gastrointestinal tract (GI). They account for approximately 0.1 to 3% of all GI neoplasms. GIST are often discovered incidentally during endoscopic procedures. Common presentations are abdominal pain, abdominal mass, iron deficiency anemia and GI obstruction. GIST are very rare to present as acute severe life threatening bleeding like our patient’s scenario. Timely surgical resection and radiologic embolization are the most effective methods in the management of GIST with acute bleeding, especially in patients with localized, non-metastatic tumors.Figure 1.: CT for abdomen showed mixed density products seen within the stomach.Figure 2.: 40 X Histologic features and patterns of gastrointestinal stromal tumor (GIST), Spindle cell GIST composed of fascicles of uniform, bland cells with pale, eosinophilic cytoplasm, Spindle cell GIST with myxoid change.Figure 3.: 20 X Histologic features and patterns of gastrointestinal stromal tumor (GIST), Spindle cell GIST composed of fascicles of uniform, bland cells with pale, eosinophilic cytoplasm, Spindle cell GIST with myxoid change.