Recurrent Lower Gastrointestinal Bleeding: Ileal GIST Diagnosed by Video Capsule Endoscopy—A Case Report and Literature Review

Introduction. Gastrointestinal stromal tumor (GIST) in the ileum is an extremely rare cause of recurrent lower gastrointestinal bleeding (GIB). Case Report. An 89-year-old man was admitted with melana. He had extensive PMH of CAD post-CABG/AICD, AAA repair, chronic anemia, myelodysplastic syndrome, lung cancer after resection, and recurrent GIB. Prior EGDs, colonoscopies, and upper device-assisted enteroscopy showed duodenal ulcer, A-V malformation s/p cauterization, and angioectasia. On admission, Hb was 6.0？g/dL. An endoscopic capsule study showed an ulcerated tumor in the ileum. CT showed no distant metastasis. The lesion was resected successfully and confirmed as a high-grade GIST. The patient was discharged with no further bleeding. Discussion. Early diagnosis for patients with ileal GIST is often challenging. Video capsule endoscopy and double balloon enteroscopy could be useful diagnostic tools. Surgical removal is the first line for a resectable GIST. Imatinib has become the standard therapy. Conclusion. This is a unique case of an ileal GIST in a patient with recurrent GIB which was diagnosed by video capsule. Complicated medical comorbidities often lead to a significant delay in diagnosis. Therefore, we recommend that if GIB does not resolve after appropriate treatments for known causes, the alternative diagnosis for occult GIB must be considered, including malignancy such as GIST. 1. Introduction Lower gastrointestinal bleeding (GIB) is the common cause of hospitalization, often involving bleeding from colitis, hemorrhoids, cancer, and vascular anomalies [1]. However, GIST is an extremely rare cause of lower GIB. GISTs are infrequent neoplasms with a reported annual incidence of 6.8 per million in the USA, more commonly occurring in middle-aged and older people with approximately equal sex distribution [2]. However, they are the most common mesenchymal malignancas of the gastrointestinal tract, which were first described by Mazur MT and Clark HB in 1983 [3]. A GIST can be located anywhere in the gastrointestinal tract, the most common sites being the stomach (63%), followed by small intestine (23%), colorectal (5%), and esophagus (1.6%) [4]. Histologically, they are mesenchymal spindle cells and immunohistochemically positive for tyrosine kinase receptor CD 117 (c-KIT), related tyrosine kinase receptor PDGFR (platelet-derived growth factor receptor α, a KIT), and CD34 expression [5]. KIT has been demonstrated as a very specific and sensitive marker to mesenchymal tumors in the GI tract and around 95% of GISTs express KIT. Depending on the