A case of melena from multiple small intestinal gastrointestinal stromal tumors via diverticula in a patient with von recklinghausen's disease

Abstract

A 65–year–old female patient was admitted to investigate the cause of repeated melena. The patient had café au lait spots and dermal nodules over the whole body and was diagnosed as von Recklinghausen′s disease. CT study revealed multiple tumors and a mesenteric angiogram revealed multiple enhanced stainings along the superior mesenteric artery area coinciding with spread of the tumors. A gastrographine study of the small bowel revealed multiple diverticulae. Laparotomy was performed with suspicion of the source of bleeding either from the diverticulae or small bowel tumors. Confluence of extramural tumors of different sizes were observed along the jejunum and ileum. Resection of the segment of small intestine with confluence of the tumors was performed and sporadically spread tumors were also removed as much as possible. Immunopathological study of the tumor was positive in KIT and CD34 and was diagnosed as multiple intestinal GIST. The diverticulae were continuous with the tumor and was thought to be the cause of bleeding.