Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal (GI) tract. These tumors are frequently small, asymptomatic and found incidentally. GI bleeding is a common complication of these tumors, but small sized, very low risk GIST rarely complicated with fatal bleeding. In this report, we describe a 42-year-old woman with a jejunal GIST accompanied by severe GI bleeding. She presented with melena and an angiographic embolization was performed for a jejunal mass with bleeding. However, rebleeding was suspected after an angiographic embolization and an emergent segmental resection for the bleeding mass was performed. She was finally diagnosed as a 1.8 cm sized very low risk GIST in jejunum. In conclusion, physician should consider that even very low risk GIST can be the cause of GI bleeding when there is severe bleeding.

Antiphospholipid antibody syndrome (APS) is characterized by raised levels of antiphospholipid antibodies (aPL), in association with thrombosis, recurrent fetal loss, and thrombocytopenia. Development of APS is related with idiopathic origin, autoimmune disease, malignancy and, on rare occasions, infection. However, in secondary APS combined with bacterial infections, aPL is usually shown with low titer and rarely associated with thrombotic events. A 52-year-old male was admitted due to pneumonia and multiple hepatosplenic abscesses. He had been treated with proper antibiotics, but he presented ascites and sudden variceal bleeding because of portal vein thrombosis. The bleeding was controlled by endoscopic variceal ligation. Acute portal vein thrombosis was successfully managed by low molecular weight heparin and hepatosplenic abscesses were completely resolved by antibiotics. This case suggests that systemic bacterial infection in immunocompetent patients possibly develops into secondary APS.

Double pylorus is one of the rare anomalies of gastrointestinal tract, which have an accessory canal connecting the distal stomach to the duodenal bulb. The majority of the cases is thought to be acquired lesions from ulcer disease except some congenital cases. We report a case of a 77 year-old male who was visited the hospital because of the melena and diagnosed double pylorus. The relevant literatures on subject were reviewed.

Bechet's disease(BD) is a chronic inflammatoroy condition involving several organs including gastrointestinal tract. Gastrointestinal tracts involvement in BD has been identified throughout the entire alimentary tract and commonly accompanies ulcerative lesions in the small and large bowel. It is debatable whether BD could be included among seronegative spondyloarthropathy (SPA).SPA usually occurs without overt sign of intestinal inflammation, but significant number of patients have asymptomatic intestinal inflammation, usually affecting ileum. Since most patients with SPA including BD are treated with NSAIDS. However, NSAID may play a role in aggravation or provocation of intestinal inflammation. Special attention to asymptomatic intestinal inflammation is needed, especially when NSAIDs are used for management of arthritic symptom in SpA. We experienced a case of BD which was complicated by a massive small bowel bleeding precipitated by NSAID use.

A case of massive intestinal bleeding from jejunal diverticulum is describe. A 62-year-old man was refered to our hospital because of melena and anemia. After admission, he showed massive hematochezia with unstable vital sign. Esophagogastroduodenocopy and colonoscopy, selective abdominal angiography, and RBC bleeding scanning were performed to seek the cause of the intestinal bleeding, but none of these studies revealed the source of bleeding. The examination of small bowel with methylcellulose showed multiple small jejunal diverticuli and a large diverticulum. Resection of the involved portion of jejunum was performed. On pathological examination, two mucosal loss lesions were detected, but ulcer or arteriovenous malformation were not seen in the resected jejunal diverticulum. The patient showed no more intestinal bleeding after operation. Although jejunal diverticuli are rare, the careful search for this complication in a patient with intestinal bleding is important.

No abstract available.