An unusual case of multiple gastrointestinal stromal tumors in the small bowel presenting as occult and overt gastrointestinal bleeding

Abstract

Gastrointestinal stromal tumors (GIST) are the most common form of mesenchymal gastrointestinal (GI) tumors. They are most commonly found in the stomach and proximal small bowel, however, may occur anywhere within the GI tract, as well as the omentum and mesentery. 1 They are responsible for approximately one percent of all GI cancers and the estimated incidence is 10-15 per million per year. The median age of diagnosis is approximately 59; however, it can range from 10-100 years old, and gender distribution is approximately equal. [1][2][3] GIST are classically solitary tumors. Multiple GISTs are usually associated with familial syndromes and sporadic multiple GISTs are rarely reported. [3][4][5][6] | CASE REPORTThe patient was a 59-year-old woman who presented initially with iron deficiency anemia (IDA) and subsequent episodes of GI bleeding. Other medical history included a posterior-lateral thoracotomy for a benign schwannoma, cholecystectomy, hypercholesterolemia, migraines, and factor V Leiden deficiency with no history of clots. Her only regular medication was rosuvastatin and she had zopiclone, metoclopramide, sumatriptan, and paracetamol as required. She had no significant family history, particularly of GI bleeding or GI malignancy.She initially had treatment for her IDA 10 years prior and required a further iron infusion two and a half years before diagnosis. Her nadir hemoglobin was 79 g/L at