Ulcerated benign jejunal gastrointestinal stromal tumor causing gastrointestinal bleeding: a case report

BACKGROUND Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors that rarely present with gastrointestinal (GI) bleeding due to tumor erosion. GISTs commonly arise in the stomach, followed by the small bowel. They are typically diagnosed through histopathology and immunohistochemistry. The presence of mucosal ulceration and tumor locations outside the stomach are linked with a greater risk of tumor progression to malignancy. This case highlights a benign ulcerated jejunal GIST presenting as GI bleeding.

CASE SUMMARY A 42-year-old male presented with dark stools and light-headedness over five days. On examination, he was hypotensive, tachycardic, tachypneic, and had pallor. Laboratory tests revealed normocytic normochromic anemia, with a significant one-day drop in hemoglobin (from 7.2 g/dL to 6.4 g/dL). Upper GI endoscopy and colonoscopy were normal, but double-balloon enteroscopy revealed a subepithelial lesion distal to the duodenojejunal flexure, and an overlying ulcer. These findings were suggestive of GIST and were corroborated by a contract-enhanced computed tomography abdomen scan, which revealed a well-defined, homogenously-enhancing solid exophytic lesion (30 mm × 22 mm × 26 mm) arising from the proximal jejunal loops. He underwent resection anastomosis with complete en-bloc surgical removal of the lesion. Histopathological analysis of the resected specimen confirmed a GIST with presence of spindle cells and positive CD117 staining. His hemoglobin levels were stable on regular follow-ups, and there was no documented recurrence six months later.

CONCLUSION GISTs should be suspected in cases of unexplained GI bleeding. Early diagnosis and complete surgical resection are key to favorable outcomes.