Acute gastrointestinal bleeding from a submucosal gastric mass
A 44-year-old male with a history of hypertension, chronic kidney disease and reflux disease, presented with upper gastrointestinal bleeding and hemodynamic instability. A month prior to admission he underwent GDS and colonoscopy because of melena. No bleeding source was found, but GDS did reveal a submucosal mass in the lesser curvature of the stomach with central erosion suggestive for ectopic pancreas therefore no biopsies or endoscopic ultrasound (EUS) were performed. shows the submucosal mass in the lesser curvature of the stomach with central erosion (black arrow).\nAt the time of admission the patient complained about melena and syncope. Physical examination revealed hypotension and tachycardia, but was otherwise unremarkable. Laboratory tests revealed low hemoglobin 5.1 mg/dL. Subsequent GDS revealed a submucosal protruding mass in the lesser curvature of the stomach with an eroded surface and bleeding stigmata, which is shown in (black arrow). This was treated with epinephrine injection and hemoclips. Computed tomography (CT) showed a mass in the stomach with a diameter of 3 × 7 cm without lymphadenopathy or signs of distant metastases. The patient was admitted to the ICU and continuous intravenous proton pump inhibitor was started. However, fluid resuscitation and blood transfusion remained necessary. Therefore, two days after admission, the patient underwent a partial gastrectomy. shows the wedge resection of the gastric mass with central hemorrhage (black arrow).\nThe submucosal mass with central erosion seen with endoscopy and CT scan was characteristic for a GIST. Histopathologic examination confirmed the diagnosis, describing an epithelioid type GIST with focal necrosis and hemorrhage with clear resection margins. Immunohistochemical examination demonstrated partial positive CD117 and CD34. shows the brown coloration of the CD117 positive tumor cells. Twelve days after admission the patient was discharged. GDS, two months after partial gastrectomy, showed no signs of recurrent disease. Seven months later the patient remains recurrence free.