Jejunojejunal intussusception with chronic bleeding caused by gastrointestinal stromal tumor: a case report and literature review

Abstract

Background: Intussusception is a rare clinical condition in adults. The majority of patients present with symptoms of bowel obstruction. Intussusception is often misdiagnosed and the majority of cases are diagnosed intraoperatively. In this paper, we present a rare case of adult jejunojejunal intussusception with chronic bleeding caused by a gastrointestinal stromal tumor (GIST). We emphasize the role of contrastenhanced computed tomography (CT) and enteroscopy in the presurgical diagnosis and the good prognosis in the high-risk GIST patient after surgery and targeted therapy.Case Description: Herein, we present the case of a 63-year-old female patient with small bowel intussusception with chronic bleeding caused by a GIST. Her main symptoms were intermittent melena and progressive anemia. She had a 20-year history of hypertension and had never undergone previous abdominal surgery. After failure of an esophagogastroduodenoscopy and colonoscopy to locate the hemorrhagic foci in the gastrointestinal tract, contrast-enhanced CT and enteroscopy were used and a small bowel intussusception and an intraluminal mass with a bleeding ulcer was identified. The patient underwent laparoscopic partial small bowel resection, and postoperative pathological examinations showed a small intestinal GIST with a high risk of recurrence. It was suggested that the patient take imatinib regularly for at least 3 years. At the time of writing, she has remained in good health without relapse for 24 months after discharge. We also review 20 published cases of intussusception caused by small bowel GIST in the PubMed database.Conclusions: Obscure gastrointestinal hemorrhage needs meticulous examinations to promptly determine the cause and location of bleeding. This case and literature review revealed that comprehensive surgical resection-centered treatment was the standard treatment for primary localized GISTs in patients at significant risk of relapse.

Gastric Antral Gastrointestinal Stromal Tumor Presenting With Severe Anemia

“…Similar to our patient, one more case presented with severe anemia and hemoglobin of 5.5 g/dL but with multiple GISTs in the stomach and small intestine [ 20 ]. Our patient’s hemoglobin dropped to 0.7 g/dL after four doses of intravenous iron supplementation; three other cases mentioned that the hemoglobin tests also demonstrated a significant drop averaging 3 g/dL in two days, three months, and eight months despite the pharmacological treatment [ 18 , 21 , 22 ]. A prompt investigation of moderate anemia in a patient, considering GIST as a differential diagnosis, should be encouraged to avoid worsening hemoglobin levels and symptomatology.…”

“…Seven cases of GIST presenting with moderate and mild anemia have been reported [16][17][18][19][20][21][22] in pediatric and adult patients. The clinical presentation included melena, fatigue, weight loss, attacks of vomiting, abdominal pain, and dyspnea.…”

Clinical significance of 18F-FDG PET/CT imaging in 32 cases of gastrointestinal stromal tumors

“…They have malignant potential, and it is widely accepted that a diameter of GIST ≥ 20 mm should be treated [8]. The diagnosis of GIST originates from the development of molecular biology, and needs to be determined by combining histological findings and immunohistochemical results [9,10]. The biological risk of GIST is closely related to the location, size, shape, density, presence or absence of necrotic cystic degeneration and calcification, presence or absence of ulceration, invasive growth and the blood supply of the tumor; but the most critical factor in determining the biological risk of GIST is its histological mitotic number, which is the proliferation state and activity of the cell.…”