SHM Converge Scientific Abstract ePoster Gallery-Unveiling an Unusual Cause of Obscure Gastrointestinal Bleeding

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This case report describes a 68-year-old man with six months of melena, fatigue, and lightheadedness due to obscure gastrointestinal bleeding. Despite extensive evaluation—including upper endoscopy, two colonoscopies, capsule endoscopy, push enteroscopy, Meckel’s scan, and CT enterography—the bleeding source remained unidentified. He required repeated emergency visits, hospitalizations, and transfusions, with hemoglobin dropping to 5.9 g/dL and a total of multiple PRBC transfusions.<br /><br />A bleeding scan localized active bleeding to the left mid-abdomen, suggesting a small bowel source. Because noninvasive testing remained negative, the surgical team performed diagnostic laparoscopy and resected a 4-inch segment of jejunum containing a hypervascular tumor. Pathology confirmed a low-grade gastrointestinal stromal tumor (GIST), spindle cell type, with low proliferative activity on Ki-67 staining.<br /><br />The report highlights that GISTs can be difficult to detect with standard endoscopic mucosal biopsies because they arise from the muscular layer of the intestinal wall rather than the mucosa. As a result, routine endoscopy may miss the lesion or show only nonspecific reactive changes. In patients with persistent obscure GI bleeding and a negative workup, less common causes such as small bowel tumors should be considered, and more invasive approaches may be necessary to establish a diagnosis.<br /><br />After resection, the patient’s hemoglobin remained stable for months, showing that surgery was both diagnostic and therapeutic. The case emphasizes the importance of using all available diagnostic tools, including laparoscopy, to reduce morbidity and mortality in obscure GI bleeding.

Asset Subtitle

Nkoyo Effiom

Meta Tag

Author List Mandvi Pandey, Nkoyo Effiom, Vaseem Ahmed

Category Clinical Vignettes

Concept Obscure Gastrointestinal Bleeding

Concept Gastrointestinal Stromal Tumor

Concept Small-Bowel Bleeding

Concept Capsule Endoscopy

Concept Enteroscopy

Distinguished Non-Finalist

Presenter Organization Texas Health Resources HEB/Denton

Presenting Author Nkoyo Effiom

Track Adult

Keywords

obscure gastrointestinal bleeding

melena

small bowel tumor

gastrointestinal stromal tumor

jejunal GIST

diagnostic laparoscopy

capsule endoscopy

CT enterography

anemia

surgical resection

Obscure Gastrointestinal Bleeding

Gastrointestinal Stromal Tumor

Small-Bowel Bleeding

Capsule Endoscopy

Enteroscopy