Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal (GI) tract. These tumors are frequently small, asymptomatic and found incidentally. GI bleeding is a common complication of these tumors, but small sized, very low risk GIST rarely complicated with fatal bleeding. In this report, we describe a 42-year-old woman with a jejunal GIST accompanied by severe GI bleeding. She presented with melena and an angiographic embolization was performed for a jejunal mass with bleeding. However, rebleeding was suspected after an angiographic embolization and an emergent segmental resection for the bleeding mass was performed. She was finally diagnosed as a 1.8 cm sized very low risk GIST in jejunum. In conclusion, physician should consider that even very low risk GIST can be the cause of GI bleeding when there is severe bleeding.

Gastrointestinal stromal tumors (GISTs) are common mesenchymal tumors that arise in the wall of the gastrointestinal tract. We report a case of obscure gastrointestinal bleeding due to a GIST of the jejunum successfully documented by videocapsule endoscopy (VCE) and single-balloon enteroscopy (SBE). A 36-year-old man with hematochezia was referred for further evaluation of no evidence of bleeding focus on esophagogastroduodenoscopy and colonoscopy. A VCE showed a suspicious ulcerative hyperemic mass that located in about 1 hour apart from duodenal second portion. SBE revealed a nonbleeding 4×2 cm mass with an ulcer at the proximal jejunum. The patient underwent laparoscopic resection without complication. Histological examination revealed a well circumscribed, dumbbell-shaped firm mass comprised of spindle cells. Immunohistochemical staining for CD 117 was diffusely positive, whereas staining for S-100, CD 34 and MIB-1 was all negative. It was confirmed to be a low-grade GIST at the proximal jejunum.

A case of massive intestinal bleeding from jejunal diverticulum is describe. A 62-year-old man was refered to our hospital because of melena and anemia. After admission, he showed massive hematochezia with unstable vital sign. Esophagogastroduodenocopy and colonoscopy, selective abdominal angiography, and RBC bleeding scanning were performed to seek the cause of the intestinal bleeding, but none of these studies revealed the source of bleeding. The examination of small bowel with methylcellulose showed multiple small jejunal diverticuli and a large diverticulum. Resection of the involved portion of jejunum was performed. On pathological examination, two mucosal loss lesions were detected, but ulcer or arteriovenous malformation were not seen in the resected jejunal diverticulum. The patient showed no more intestinal bleeding after operation. Although jejunal diverticuli are rare, the careful search for this complication in a patient with intestinal bleding is important.