S6194 Beyond the Scope: Jejunal GIST Causing Recurrent GI Bleeding

Introduction: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms originating from the interstitial cells of Cajal, capable of arising anywhere in the gastrointestinal (GI) tract. Jejunal GISTs are particularly uncommon, representing only 0.1–3% of all GI tumors. While often asymptomatic or presenting with vague symptoms, they can occasionally cause overt bleeding. We present a case of recurrent GI hemorrhage due to a jejunal GIST that eluded detection despite extensive standard diagnostic evaluation. Case Description/Methods: A 48-year-old man with a history of gastroesophageal reflux disease presented with recurrent gastrointestinal bleeding. Three years prior, he experienced bleeding and computed tomography Angiogram revealing an active arterial hemorrhage in the jejunum. However, IR angiography failed to identify an active source, and capsule endoscopy was unremarkable. The patient returned 3 years later with recurrent blood per rectum. Repeat computed tomography Angiogram demonstrated possible bleeding in the jejunum. Capsule endoscopy, nuclear medicine Meckel scan, and GI bleeding scan were all unremarkable. Patient returned 2 months later with shortness of breath, and noted to have drop in hemoglobin to 6.6 g/dL. Repeat computed tomography angiography (CTA) showed persistent enhancement in the left upper quadrant jejunum. Push enteroscopy identified a large ulcerated mass in the proximal jejunum. The patient was referred to surgical oncology and underwent laparoscopic small bowel resection with >5 cm proximal and distal margins. Histopathology confirmed gastrointestinal stromal tumor (GIST). Staging done and patient determined to be Stage 1. The patient is undergoing surveillance imaging with hematology-oncology every 3–6 months. Discussion: This case illustrates an uncommon presentation of recurrent GI bleeding from a jejunal GIST that remained undetected on multiple modalities, including CTA, esophagogastroduodenoscopy, colonoscopy, and capsule endoscopy. Given the limited visualization of the jejunum via standard endoscopic techniques, pathology in this segment may be easily missed.