Abstract
The patient was a 66-year-old male who visited our hospital with the chief complaint of hematochezia. No source of bleeding was observed in the upper and lower intestinal endoscopic examinations. The abdominal CT scanning with contrast medium revealed a tumor of 4cm diameter in the prximal jejunum. The abdominal angiography showed a pachychromatic image of a tumor in the upper jejunum, suggesting a small intestinal GIST. As hematochezia occurred repeatedly during the said tests and blood pressure dropped, and as hemorrhage from the small intestinal tumor was discovered an emergency operation was performed. Laparotomy revealed a tumor of 5cm diameter growing extramurally at 10cm from the Treitz's ligament contralaterally to the mesenterium. A 10cm portion of the small intestine was excised. Histopathological examination revealed a growth of spindle-shaped cells with small blood vessels and increased cell density. Immunostaining confirmed GIST. It is often difficult to detect small intestinal GIST in patients who present with hematochezia. We present a list of cases reported in the past and discuss the differential diagnosis based on imaging and locality.
