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Case Reports
. 2021 Jan 18:2021:6674612.
doi: 10.1155/2021/6674612. eCollection 2021.

Acute Gastrointestinal Bleed from a Gastrointestinal Stromal Tumour Impersonating an Arteriovenous Malformation of the Jejunum

Oshan Basnayake  1 , Umesh Jayarajah  1 , Nilesh Fernandopulle  2 , Sivasuriya Sivaganesh  2
Affiliations
Case Reports

Acute Gastrointestinal Bleed from a Gastrointestinal Stromal Tumour Impersonating an Arteriovenous Malformation of the Jejunum

Oshan Basnayake et al. Case Rep Surg. .

Abstract

Gastrointestinal stromal tumours (GIST) are neoplasms which originate from the mesenchymal tissue of the gastrointestinal tract. We report on a GIST presenting with acute gastrointestinal bleeding that mimicked an arteriovenous malformation (AVM) on imaging and at surgery. A 61-year-old female presented with a short history of melaena and severe anaemia. After resuscitation, upper gastrointestinal endoscopy showed a profusely bleeding varix in the proximal jejunum which was treated with glue injection. Contrast-enhanced CT showed a heterogeneous lesion in the proximal jejunum with strong arterial phase enhancement, supplied by a branch of the superior mesenteric artery and drained by a prominent tributary of the superior mesenteric vein, suggestive of an AVM. The mass was resected, and histology revealed a GIST with no evidence of an AVM or angiodysplasia. A GIST may be considered, though imaging suggests a diagnosis of an AVM in patients presenting with acute gastrointestinal bleeds. In such circumstances, surgical resection and pathological assessment will be confirmatory.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Yellow arrow shows the endoscopic appearance of bleeding varix at proximal jejunum.
Figure 2
Figure 2
Coronal view of contrast-enhanced CT scan image arterial phase: yellow arrow shows the jejunal lesion; red arrow shows the contrast enhancement of superior mesenteric vein.
Figure 3
Figure 3
Intraoperative image: red arrow shows the jejunal lesion; yellow arrow shows the main feeding vessel through mesentery.
Figure 4
Figure 4
Resected specimen: red arrow shows the jejunal lesion; yellow arrow shows part of the jejunum.
Figure 5
Figure 5
Macroscopic appearance of the tumour cross-section: red arrows show the jejunal lesion arising from the wall; yellow arrows show the jejunal lumen.
See this image and copyright information in PMC

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