Unusual case report of bifocal gastrointestinal stromal tumor in the first jejunal loop uncovered by severe hemorrhage

Abstract

INTRODUCTION AND IMPORTANCE: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors, constituting 1 % of gastrointestinal tumors. Jejunal GISTs are even rarer. This article describes a unique bifocal jejunal GIST case, revealed by an exceptionally rare instance of massive hemorrhage. CASE PRESENTATION: We present a 60-year-old female admitted for two days of melena. Despite being hemodynamically stable, severe anemia was noted. Initial endoscopy was normal, but further imaging and jejunoscopy revealed two jejunal GISTs. Surgical resection confirmed the diagnosis. Postoperative recovery was uneventful, with no bleeding recurrence after one year. CLINICAL DISCUSSION: Gastrointestinal stromal tumors (GISTs) are rare but the most common mesenchymal neoplasms in the gastrointestinal tract, originating from interstitial cells of Cajal. Jejunal GISTs are particularly rare but can cause severe gastrointestinal bleeding, even if small. Diagnosis is challenging and often confirmed by angio-CT. Upper and lower endoscopies are initial steps in evaluating gastrointestinal bleeding, but jejunal GISTs may not be visible due to limited access. In such cases, jejunoscopy and video capsule endoscopy can be particularly valuable for direct visualization and assessment of the jejunum, as demonstrated in our patient, where jejunoscopy enabled precise diagnosis. Complete surgical resection is the recommended treatment, with CD-117 positivity confirming the diagnosis. CONCLUSION: This case highlights the rare presentation of bifocal jejunal GISTs with severe hemorrhage and emphasizes the need for prompt surgical intervention and awareness of atypical cases.