Diagnostic and Therapeutic Challenges in the Management of Acute Massive Overt Bleeding of Jejunal Gastrointestinal Stromal Tumours: Case Series

Abstract

Jejunal Gastro-Intestinal Stromal Tumours (GIST) are rare mesenchymal tumours. Acute massive overt bleeding from jejunal GIST are very rare and poses both diagnostic and therapeutic challenges in emergent conditions. MethodsA case series with retrospective analysis of prospectively maintained database of patients presenting with acute massive overt bleeding secondary to histologically proven jejunal GIST was done. Clinical characteristics, endoscopic and imaging diagnostic features, histological ndings, surgical procedures and outcomes in these patients were studied. ResultsThree patients were included in this case series. Mean age of presentation was 49.0 years with two male and one female patient. All three patients presented with melena and hemodynamic instability, resuscitated with adequate blood transfusions. Routine endoscopic assessment were inconclusive.Multiphasic Computed Tomographic Angiography (CTA) revealed hypodense hypervascular mass in jejunum in all three patients. One patient was unresponsive to blood transfusion and underwent emergency exploratory laparotomy. One patient underwent laparoscopic resection and reconstruction. Mean length of hospital stay was 5.3 days. Histopathological examination con rmed Jejunal GIST in all three patients with microscopically negative resection margins. Two patients were disease free till 18 months follow up and the one patient lost to follow up after 1 year. ConclusionMultiphasic CTA is a single step diagnostic tool for localisation of bleed and assessment of tumour characteristics in emergent conditions. Surgical resection is the mainstay of treatment for both control of bleed and to provide oncologically clear resection margins.

Surgical management of a locally advanced jejunal stromal tumor: A case report of a challenging condition

“…Abdominal pain, small bowel obstruction, and bowel perforation are also reported symptoms [ 5 ]. Due to the non-specific clinical and imaging findings, and the challenges of accessing the tumor site using conventional endoscopy, arriving at a definitive diagnosis of jejunal GIST, prior to surgery, remains challenging [ 2 ]. In the case of our patient, given the inaccessibility of the tumor through standard endoscopic methods, and with double-balloon endoscopy and video capsule unavailable, a decision to proceed with potentially curative surgery based on CT scan findings was reached through a multidisciplinary hearing.…”

“…While the stomach accounts for the most common location in the majority of studies, comprising 55 % of all diagnosed GISTs, 31 % are found in the small bowel, and less than 6 % originate from the colorectal region [ 1 ]. At the initial diagnosis, a significant 88 % of GIST cases are localized and amenable to surgical resection, with only a mere 1.6 % classified as locally advanced, and 10 % presenting with metastasis [ 2 ]. Locally advanced jejunal stromal tumors stand as a captivating and relatively rare entity, garnering attention for several reasons.…”

Jejunal Gastrointestinal Stromal Tumor: A Strange Cause of Massive Gastrointestinal Bleeding

“…The most common symptom is GI bleeding (30-40%), followed by abdominal pain (20-50%), and obstruction (10-30%). Massive bleeding with hemodynamic instability is rare and lifethreatening, and the hemorrhage may be intra-luminal or, rarely, intra-peritoneal [2,5,8].…”

Jejunal gist simulating a uterine myoma: A case report

“…Visceral arteriography can detect bleeding in the upper GI tract at rates as low as 0.5 ml/min and it also has the ability to define in greater detail the vascular anatomy which can help to find the origin of the lesions [11] such as the case that has been exposed in this review. Recently, a small series of cases has been published showing the usefulness of CT for the management of acute massive over bleeding due to jejunal GIST [12] .…”