Published online Dec 6, 2020. doi: 10.12998/wjcc.v8.i23.6009
Peer-review started: April 13, 2020
First decision: June 18, 2020
Revised: July 27, 2020
Accepted: October 12, 2020
Article in press: October 12, 2020
Published online: December 6, 2020
Processing time: 235 Days and 8.9 Hours
Gastrointestinal stromal tumors (GISTs) are mesenchymal tissue tumors originating from Cajal cells, presenting diverse clinical manifestations due to the different sizes, locations, and growth patterns of the lesions. Duodenum is an uncommon site of GISTs, more with gastrointestinal obstruction and bleeding as the first symptoms. Ectopic duodenal varix, as a rare varix occurring outside the gastroesophageal region, is the main type of heterotopic varices and an unusual cause of gas-trointestinal hemorrhage. The etiology is mainly seen in liver cirrhosis, portal hypertension, vasculitis, portal vein embolism and obstruction caused by various factors. Reports of duodenal stromal tumor combined with ectopic variceal hemorrhage are rarely seen; however, when it occurs, the situation can sometimes be urgent and life-threatening, especially when traditional endoscopy and imaging fail to detect the lesion timely.
We report a 52-year-old female patient who had no obvious inducement to develop black stool. Gastroscopy in a local hospital revealed that the duodenal horizontal ectopic varices were ruptured and bleeding. After metal clamping hemostasis, she still had gastrointestinal bleeding and was transferred to our hospital. Gastroscopy showed that active bleeding was still seen in the horizontal part of duodenum, and suspicious submucosal eminence was seen in the bleeding part. Abdominal computed tomography showed a huge stromal tumor of duodenum, specimens were pathologically confirmed after surgery. After a 3-mo follow-up, no gastrointestinal hemorrhage and complications occurred.
Ectopic variceal hemorrhage is rare but sometimes fatal. It may be combined with stromal tumor, which can be diagnosed by multiple methods. Endoscopic and surgical treatment are effective.
Core Tip: Giant duodenal stromal tumor with ectopic variceal hemorrhage as the initial symptom is extremely rare in the clinic. For gastrointestinal hemorrhage caused by rare sites and causes, meticulous and skillful endoscopic examination technology can prevent focus from missing, while multiple methods (computed tomography, endoscopy, etc.) are of great value in clarifying the etiology and reducing missed diagnosis.