Gastrointestinal Stromal Tumor Masquerading as a Spontaneous Rectal Hematoma

Abstract

A 78-year-old Caucasian male with a history of atrial fibrillation and anticoagulation with warfarin presented with a change in bowel habits and weight loss. A computed tomography (CT) scan showed a 3.5 cm rectal mass. After biopsy with colonoscopy and endoscopic ultrasonography, the rectal mass was highly suspicious for rectal hematoma. When the rectal mass did not resolve after 1 month of follow-up, surgery showed the patient to have a rectal gastrointestinal stromal tumor. He is being treated with imatinib and follow-up CT scans. This case illustrates the importance of a high level of suspicion for a gastrointestinal stromal tumor when a rectal mass is found.

Rectal Hematoma Mimicking as a Gastrointestinal Stromal Tumor: An Atypical Endoscopic Ultrasound Finding

“…The most common sites of GIST involvement are the stomach (40-60%), small intestine (25-30%), colon/rectum (15%), and esophagus (<1%) [ 4 ]. Most GISTs originate from within the muscularis propria, whereas small lesions may originate from the muscularis mucosa [ 5 , 6 ]. On endoscopy, GIST appears as a submucosal mass with smooth margins, with normal overlying mucosa, and bulging into the gastrointestinal lumen.…”

“…Central ulceration is occasionally seen [ 5 ]. On EUS, GISTs appear as hypoechoic, homogeneous lesions with well-defined margins, although they can rarely have irregular margins and ulcerations [ 5 , 6 ].…”

“…Rectal hematomas can clinically present as an intestinal obstruction or change in bowel habits [ 6 ]. As small as 30 ml of hematoma can cause symptomatic small bowel obstruction, but a larger amount of blood is needed to produce colonic obstruction [ 6 ].…”

“…Rectal hematomas can clinically present as an intestinal obstruction or change in bowel habits [ 6 ]. As small as 30 ml of hematoma can cause symptomatic small bowel obstruction, but a larger amount of blood is needed to produce colonic obstruction [ 6 ]. In our patient, both colonoscopy with biopsy and EUS-guided FNA demonstrated blood and was negative for any malignancy, which raised our suspicion of rectal hematoma.…”

Spontaneous presacral haematoma mimicking rectal malignancy - an unusual consequence of anticoagulation

“…Although admittedly atraumatic presacral haematoma is rare, rectus sheath, preperitoneal and retroperitoneal haematomata are much more common, sometimes occult, and potentially catastrophic 6. In all cases, reversal of warfarin should be considered in context with the original indication for anticoagulation and the degree of bleeding, by either vitamin K (h), prothrombin complex (min), or flesh frozen plasma (min).…”