Epidemic Kaposi's sarcoma remains the most common cancer in patients with human immunodeficiency virus and is associated with significant morbidity and mortality in AIDS patients. Primary visceral Kaposi's sarcoma (Kaposi's sarcoma without cutaneous lesions) presenting with lower gastrointestinal bleeding (LGIB) has rarely been reported. Though Kaposi's sarcoma can occur anywhere in gastrointestinal tract, gastrointestinal symptoms are often non-specific such as chronic blood loss anaemia, vomiting, diarrhoea, intestinal obstruction. In these patients, severe gastrointestinal bleeding requiring repeated blood transfusions is extremely rare. Clinicians should be aware of gastrointestinal tract Kaposi's sarcoma since visceral Kaposi's sarcoma can present in the absence of cutaneous involvement. Endoscopy with biopsy is useful in the diagnosis for severe LGIB in patients with AIDS. Furthermore, gastrointestinal Kaposi's sarcoma should be considered in the differential diagnosis of GI bleeding. We report a case of primary colonic KS who presented with recurrent GI bleeding which was eventually diagnosed by sigmoidoscopy and confirmed pathologically.
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.
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