Obscure Gastrointestinal Bleeding Due to a Small Intestinal Gastrointestinal Stromal Tumor in a Young Adult

Abstract

The source of most cases of gastrointestinal bleeding is the upper gastrointestinal tract. Since bleeding from the small intestine is very rare and difficult to diagnose, time is required to identify the source. Among small intestine bleeds, vascular abnormalities account for 70-80%, followed by small intestine tumors that account for 5-10%. The reported peak age of the onset of small intestinal tumors is about 50 years. Furthermore, rare small bowel tumors account for only 1-2% of all gastrointestinal tumors. We describe a 29-year-old man who presented with obscure anemia due to gastrointestinal bleeding and underwent laparotomy. Surgical findings revealed a well-circumscribed lesion measuring 45 × 40 mm in the jejunum that initially appeared similar to diverticulosis with an abscess. However, the postoperative pathological diagnosis was a gastrointestinal stromal tumor with extramural growth.

Keywords: Gastrointestinal stromal tumors; Small bowel bleeding; Small bowel tumor; Young adult.

Fig. 1

Computed tomography findings. White arrow, well-delineated 45 × 40-mm mass in the jejunum.

Fig. 2

Intraoperative view. White arrow, well-circumscribed 45 × 40-mm lesion with inflammatory adhesion.

Fig. 3

Resected specimen. a Dissected jejunum shows swollen diverticulosis. b Cross-sectional slice shows infected diverticulosis with abscess. Pathological findings revealed GIST with extramural growth.

Fig. 4

Pathological examination of the tumor. a The tumors consisted of spindle cells (hematoxylin and eosin staining, ×100). b Immunohistochemically, the atypical cells positively reacted to c-kit (×100). MIB-1 labeling index was <1%.