Reuter S, Bettenworth D, Mees ST, Neumann J, Beyna T, Domschke W, Wessling J, Ullerich H. A typical presentation of a rare cause of obscure gastrointestinal bleeding. World J Gastrointest Endosc 2011; 3(2): 40-45 [PMID: 21403816 DOI: 10.4253/wjge.v3.i2.40]
Corresponding Author of This Article
Stefan Reuter, MD, Department of Internal Medicine D, University Hospital Münster, Albert-Schweitzer Str. 33, Münster 48149, Germany. sreuter@uni-muenster.de
Article-Type of This Article
Case Report
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World J Gastrointest Endosc. Feb 16, 2011; 3(2): 40-45 Published online Feb 16, 2011. doi: 10.4253/wjge.v3.i2.40
A typical presentation of a rare cause of obscure gastrointestinal bleeding
Stefan Reuter, Dominik Bettenworth, Sören Torge Mees, Jörg Neumann, Torsten Beyna, Wolfram Domschke, Johannes Wessling, Hansjörg Ullerich
Stefan Reuter, Department of Internal Medicine D, University Hospital Münster, Albert-Schweitzer Str. 33, Münster 48149, Germany
Dominik Bettenworth, Torsten Beyna, Wolfram Domschke, Hansjörg Ullerich, Department of Internal Medicine B, University Hospital Münster, Albert-Schweitzer Str. 33, Münster 48149, Germany
Sören Torge Mees, Department of General and Visceral Surgery, University Hospital Münster, Albert-Schweitzer Str. 33, Münster 48149, Germany
Jörg Neumann, Gerhard Domagk Institute of Pathology, University Hospital Münster, Albert-Schweitzer Str. 33, Münster 48149, Germany
Johannes Wessling, Department of Radiology, University Hospital Münster, Albert-Schweitzer Str. 33, Münster 48149, Germany
Author contributions: Reuter S and Bettenworth D contributed equally to this work; Reuter S, Bettenworth D, Domschke W, and Ullerich H wrote the paper; and Beyna T, Mees ST, Neumann J, and Wesseling J provided data.
Correspondence to: Stefan Reuter, MD, Department of Internal Medicine D, University Hospital Münster, Albert-Schweitzer Str. 33, Münster 48149, Germany. sreuter@uni-muenster.de
Telephone: +49-251-8356983 Fax: +49-251-8356973
Received: October 21, 2010 Revised: December 19, 2010 Accepted: December 6, 2010 Published online: February 16, 2011
Abstract
A 52-year-old white woman had suffered from intermittent gastrointestinal (GI) bleeding for one year. Upper GI endoscopy, colonoscopy and peroral double-balloon enteroscopy (DBE) did not detect any bleeding source, suggesting obscure GI bleeding. However, in videocapsule endoscopy a jejunal ulceration without bleeding signs was suspected and this was endoscopically confirmed by another peroral DBE. After transfusion of packed red blood cells, the patient was discharged from our hospital in good general condition. Two weeks later she was readmitted because of another episode of acute bleeding. Multi-detector row computed tomography with 3D reconstruction was performed revealing a jejunal tumor causing lower gastrointestinal bleeding. The patient underwent exploratory laparotomy with partial jejunal resection and end-to-end jejunostomy for reconstruction. Histological examination of the specimen confirmed the diagnosis of a low risk gastrointestinal stromal tumor (GIST). Nine days after surgery the patient was discharged in good health. No signs of gastrointestinal rebleeding occurred in a follow-up of eight months. We herein describe the complex presentation and course of this patient with GIST and also review the current approach to treatment.
