Jejunal GIST: Hunting down an unusual cause of gastrointestinal bleed using double balloon enteroscopy. A case report

Dualim, Diana Mellisa; Loo, Guo Hou; Rajan, Reynu; Mahmood, Nik Ritza Kosai Nik

doi:10.1016/j.ijscr.2019.06.053

Cited by 14 publications

(17 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Acute GI bleeding is a common presentation in medical practice and can present as a life-threatening abdominal emergency. Bleeding from the small intestinal is only found in 5–10% of patients presenting with a GI bleed [ 4 ]. The main aetiologies of small bowel intestinal bleeding include:…”

Section: Discussionmentioning

confidence: 99%

“…Meckel’s diverticulum and inflammatory bowel disease are common in patients <40 years old, whereas angioectasia and ulcers secondary to anti-inflammatory medications are more common in patients >40 years old [ 4 ]. There are only a few case reports of a jejunal GIST being the cause of small intestinal bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…Small intestinal bleeding is a diagnostic challenge as this region is inaccessible by conventional endoscopy. The imaging modalities required after negative upper and lower GI endoscopy include capsule endoscopy, CT angiography, conventional CT scan with IV +/−oral contrast, double balloon enteroscopy and magnetic resonance enterography [ 4 ]. CT scan features of small intestinal GISTs include a well-circumscribed extraluminal mass with homogeneous enhancement in small tumours and heterogeneous enhancement due to a necrotic centre in large tumours.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Massive bleeding of a jejunal gastrointestinal stromal tumour: a rare case of a life-threatening presentation

Mahmoud¹,

Salman²

2020

Journal of Surgical Case Reports

View full text Add to dashboard Cite

A jejunal gastrointestinal stromal tumour (GIST) is a rare neoplasm of the gastrointestinal tract. Massive bleeding due to a jejunal GIST is a diagnostic challenge and could present as a life-threatening situation needing urgent intervention. A 54-year-old woman presented with episodes of melaena and haematochezia for the previous 3 days. An oesophagoduodenoscopy was inconclusive. A contrast computed tomography (CT) scan showed a well-defined extraluminal mass in the proximal jejunum suggestive of a bleeding GIST. Her haemodynamic state deteriorated despite initial supportive therapy including a blood transfusion. An urgent laparotomy to excise the jejunal mass was performed. Histopathology and immunohistochemical studies confirmed the diagnosis. She subsequently received adjuvant imatinib therapy. She has remained symptom free at 5 months post-op. We therefore present a rare case of obscure massive gastrointestinal bleeding due to a jejunal GIST. The CT scan was the most effective investigation to detect the source of bleeding in this case.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Massive bleeding of a jejunal gastrointestinal stromal tumour: a rare case of a life-threatening presentation

Mahmoud¹,

Salman²

2020

Journal of Surgical Case Reports

View full text Add to dashboard Cite

show abstract

“…The commonest symptom is GI bleeding, which is seen in half of the patients, followed by pain abdomen in 20 to 50% and GI obstruction in up to 30% patients. 16 Patients can have melena, abdominal fullness, and palpable mass. They can metastasize to the liver but rarely other organs.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Double Balloon Enteroscopy for Managing Overt Small Bowel Bleeding

Dalal

Patil

Maydeo

2020

Journal of Digestive Endoscopy

View full text Add to dashboard Cite

Abstract Background The commonest therapeutic indications for double balloon enteroscopy (DBE) includes removal of retained video capsules, dilatation of strictures, polypectomy, and managing obscure small bowel bleeding. We review our experience in managing active small bowel bleeding with DBE. Methods A retrospective review was done for all the cases undergoing DBE from August 2017 to July 2019. Patient follow-up data was collected. Results Among 25 cases with a median age of 46.8 (range 25–65 years), 17 males (68%) underwent DBE for suspected small bowel bleeding. The commonest presenting complaint was melena 19 (76%). The findings were positive (diagnostic yield) in 18 (72%) patients with an antegrade approach. Active bleeding was associated with Dieulafoy's lesion (n = 6), gastrointestinal stromal tumors (GIST) (n = 4), jejunal varices (n = 3), angioectasia (n = 3), and ulcer (n = 2), who then underwent successful intervention. The rest of the patients underwent both antegrade and retrograde approach but failed to immediately identify an alternative diagnosis. Mean (standard deviation [SD]) time taken for antegrade enteroscopy was 96.7 (15.3) mins and 67.8 (13.6) mins for retrograde enteroscopy. The median duration between the last bleeding episode and timing of DBE was 9 (range 6–15 hours). No major complications were seen during or immediately postprocedure. Conclusion DBE is useful in identifying and treating active small bowel bleeding. Being invasive and time-intensive, it is easy to miss lesions and, therefore, needs appropriate expertise. DBE does appear to be relatively cheaper, with better patient acceptance and time saving.

show abstract

“…Plain chest and abdomen radiographs help in identifying those patients with an obstruction or perforation but are nonspecific to GISTs. Dualim DM et al highlighted the use of a capsule endoscopy and double balloon enteroscopy in the diagnosis of a bleeding jejunal GIST [19]. Barium studies and enteroclysis provides information regarding the presence or absence of a mass but is not specific for GISTs.…”

Section: Discussionmentioning

confidence: 99%

Small Intestine Gastrointestinal Stromal Tumour—A Case Report

Sridharan¹,

Kumar²,

Dinesh³

et al. 2020

CRCM

View full text Add to dashboard Cite

Gastrointestinal stromal tumours (GIST) are mesenchymal tumours that arise most commonly from the stomach. They are the 3 rd most common tumour diagnosed behind adenocarcinomas and lymphomas. The majority of these tumours are asymptomatic and incidentally diagnosed in UGI scopy or contrast enhanced CT abdomen and pelvis studies. Obstruction, ulceration, gastrointestinal (GI) haemorrhage and perforation warrants an urgent surgical intervention. GIST is medically managed by tyrosine kinase inhibitors and surgically by resection and anastomosis. This case report highlights the diagnosis and management of a 42-year-old gentleman who presented with vague right iliac fossa mass. Informed consent was obtained from the patient for publication of this case. This case was chosen to be reported because of the rare incidence of small intestine GIST in South India and the effectiveness of minimally invasive laparoscopic surgery in management.

show abstract

Jejunal GIST: Hunting down an unusual cause of gastrointestinal bleed using double balloon enteroscopy. A case report

Cited by 14 publications

References 10 publications

Massive bleeding of a jejunal gastrointestinal stromal tumour: a rare case of a life-threatening presentation

Massive bleeding of a jejunal gastrointestinal stromal tumour: a rare case of a life-threatening presentation

Outcomes of Double Balloon Enteroscopy for Managing Overt Small Bowel Bleeding

Small Intestine Gastrointestinal Stromal Tumour—A Case Report

Contact Info

Product

Resources

About