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Case Report

Fatal Small Bowel Bleeding with very Low Risk Gastrointestinal Stromal Tumor in Jejunum

Jae Bin Kang, Jae Myung Cha, Joung Il Lee, Kwang Ro Joo, In Taik Hong, Hye Jin Ki
The Ewha Medical Journal 2015;38(2):72-75. Published online: July 29, 2015

Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.

Corresponding author: Jae Myung Cha. Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 134-727, Korea. Tel: 82-2-440-6113, Fax: 82-2-440-6295, drcha@khu.ac.kr
• Received: March 26, 2015   • Accepted: June 3, 2015

Copyright © 2015, The Ewha Medical Journal

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • 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.
  • Keywords: Jejunum; Small bowel; Neoplasm; Gastrointestinal stromal tumor; Bleeding
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Fig. 1

Abdominal computed tomography finding. It shows extravasation of contrast agent with 1.5 cm sized filling detect (black arrow). It allows assessment of active bleeding in proximal jejunal loop with small mass.

emj-38-72-g001.jpg
Fig. 2

Superior mesenteric artery angiography. Active extravasation is noted from the 1st jejunal branch (black arrow).

emj-38-72-g002.jpg
Fig. 3

Gross findings of resected specimen. (A) It shows a 1.8×1.5×1.5 cm sized, encapsulated lobulating mass with hemorrhage. (B) The cut surface shows a gray-white solid tumor with multifocal hemorrhages (black arrow).

emj-38-72-g003.jpg
Fig. 4

Microscopic findings of resected specimen. (A) It reveals spindle shaped cells arranged in fascicular pattern (H&E, ×400). (B) In immunohistochemical staining, the tumor cells are positive for c-kit (c-kit stain, ×200).

emj-38-72-g004.jpg

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      Fatal Small Bowel Bleeding with very Low Risk Gastrointestinal Stromal Tumor in Jejunum
      Ewha Med J. 2015;38(2):72-75.   Published online July 29, 2015
      DOI: https://doi.org/10.12771/emj.2015.38.2.72
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      Fatal Small Bowel Bleeding with very Low Risk Gastrointestinal Stromal Tumor in Jejunum
      Ewha Med J. 2015;38(2):72-75.   Published online July 29, 2015
      DOI: https://doi.org/10.12771/emj.2015.38.2.72
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      Fatal Small Bowel Bleeding with very Low Risk Gastrointestinal Stromal Tumor in Jejunum
      Image Image Image Image
      Fig. 1 Abdominal computed tomography finding. It shows extravasation of contrast agent with 1.5 cm sized filling detect (black arrow). It allows assessment of active bleeding in proximal jejunal loop with small mass.
      Fig. 2 Superior mesenteric artery angiography. Active extravasation is noted from the 1st jejunal branch (black arrow).
      Fig. 3 Gross findings of resected specimen. (A) It shows a 1.8×1.5×1.5 cm sized, encapsulated lobulating mass with hemorrhage. (B) The cut surface shows a gray-white solid tumor with multifocal hemorrhages (black arrow).
      Fig. 4 Microscopic findings of resected specimen. (A) It reveals spindle shaped cells arranged in fascicular pattern (H&E, ×400). (B) In immunohistochemical staining, the tumor cells are positive for c-kit (c-kit stain, ×200).

      Fig. 1

      Fig. 2

      Fig. 3

      Fig. 4

      Fatal Small Bowel Bleeding with very Low Risk Gastrointestinal Stromal Tumor in Jejunum
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