E0661 - Jejunal Gastrointestinal Stromal Tumor (GIST) as a Rare Cause of Lower GI Bleed

Tripti Nagar, MD¹, Alaa Taha, MD², Vatsal Khanna, MD³, Aldin Jerome, MD¹, Ranim Chamseddin, MD¹, Abdullah Yesilyaprak, MD^1
1Wayne State University, Rochester, MI; ²Wayne State University School of Medicine, Rochester, MI; ³Wayne State University School of Medicine, Rochester Hills, MI

Introduction: Gastrointestinal stromal tumors (GIST) are mesenchymal neoplasms that range from asymptomatic to nonspecific presenting symptoms of nausea, vomiting, and abdominal fullness. The prevalence of GIST is approximately 1% of all gastrointestinal (GI) malignancies. We present a rare case of occult lower GI bleeding leading to a diagnosis of GIST in a 53-year-old patient.

Case Description/Methods: A 53-year-old male without prior medical history was evaluated after a syncopal episode. He was found to have hemodynamically significant anemia requiring multiple units of packed red blood. Endoscopy revealed gastric erosions without active bleeding. The patient became febrile after transfusion, prompting infectious workup including abdominal CT evaluation. A 11.4 x 8.6 x 13.8 cm a collection with wall thickening and adjacent mesenteric fat stranding was seen, contiguous within the jejunum. MRI evaluation confirmed these findings with an additional borderline enlarged para-aortic lymph node. Empiric antibiotic therapy with cefepime and metronidazole was initiated until infectious etiology was ruled out including negative blood cultures. Subsequently, the patient underwent exploratory laparotomy with small bowel resection. Intraoperative course was uncomplicated but significant for colonic and omental adhesions. Metastatic workup while awaiting biopsy results was negative. Histopathology reports confirmed spindle cell GIST of the jejunum with diffusely positive CD117 and patchy CD34 expression and negative margins. He was initiated on oral chemotherapy and cleared for discharge.

Discussion: Overt GI bleeding as the initial symptoms of jejunal GIST is uncommon with literature review demonstrating 2 previous case reports of similar presentations. Arriving at a definitive diagnosis can be difficult given that bleeding can occur for years before being apparent to the patient. Also, endoscopic detection can be masked until the tumor size is rather large. Given these challenges, often GIST diagnosis requires exploratory laparotomy and subsequent biopsy. Tumor excision with negative margins is performed with curative intent. This case illustrates the need to maintain a wide differential to GI bleeding due to malignancies in order to allow for early detection, intervention, and treatment initiation.



Disclosures:


Tripti Nagar, MD¹, Alaa Taha, MD², Vatsal Khanna, MD³, Aldin Jerome, MD¹, Ranim Chamseddin, MD¹, Abdullah Yesilyaprak, MD¹. E0661 - Jejunal Gastrointestinal Stromal Tumor (GIST) as a Rare Cause of Lower GI Bleed, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.