S4816 Multifocal Jejunal GIST Presenting With Gastrointestinal Bleeding: A Case Report and Literature Review

Introduction: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms originating from the interstitial cells of Cajal, accounting for 1%–2% of all primary gastrointestinal (GI) tumors. They occur most commonly in the stomach, followed by the small bowel. Of all small bowel GISTS, ∼10% arise in the jejunum, and ∼25% present with GI bleeding; sporadic multifocal cases of GISTs are rare. Diagnosis is based on imaging, histopathology, and immunohistochemical (IHC) staining, notably for CD117. We present a case of bleeding sporadic multifocal jejunal GIST to highlight diagnostic challenges and discuss management in the context of a literature review. Case Description/Methods: A 56-year-old woman presented for 2 months of abdominal pain, melena, maroon-colored stool, nausea, and fatigue. Relevant medical history included 2 remote episodes of GI bleeding with normal esophagogastroduodenoscopies (EGDs) and colonoscopies. Capsule endoscopy at that time revealed a jejunal nonbleeding lesion. Her history included a Cesarean section and smoking without liver disease, nonsteroidal anti-inflammatory drug, alcohol, or illicit drug use. On admission, she was afebrile with a blood pressure of 100/60, heart rate of 102, and respiratory rate of 18. Physical exam revealed periumbilical tenderness, hyperactive bowel sounds, external hemorrhoids, and black tarry stool. Bloodwork showed severe anemia that improved with fluid resuscitation and blood transfusion. Computed tomography revealed a potential small bowel mass, confirmed by magnetic resonance enterography. Repeat esophagogastroduodenoscopy and colonoscopy were negative for a mass or bleeding source. Ongoing hemoglobin drops and symptoms led to an exploratory laparotomy, resulting in resection of a multifocal mid-to-distal jejunal mass. IHC stains were positive for CD117 and other GIST-associated markers, diagnosing multifocal GIST. She recovered well and was discharged on imatinib therapy. At 1-year follow-up, she remained symptom-free and in good health. Discussion: A literature review identified 2 reports of Neurofibromatosis type 1 (NF1)–associated bleeding multifocal jejunal GISTs. To our knowledge, this is the first reported case of a sporadic bleeding multifocal jejunal GIST. The importance of GIST inclusion in the differential diagnosis of obscure GI bleeding, particularly when endoscopic evaluation is negative, is crucial. Early recognition and intervention are critical; delayed diagnosis may lead to increased morbidity and mortality—especially in resource-limited settings.