S3600 GIST: An Unusual Cause of Upper Gastrointestinal Bleeding

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INTRODUCTION: Upper gastrointestinal bleed (UGIB) is a prevalent condition and can be divided into acute or chronic on the basis of onset. The most frequent etiology of acute UGIB is peptic ulcer disease. Gastrointestinal stromal tumor (GIST) is an uncommon neoplasm and can rarely present with gastrointestinal bleeding. Here we report a case of a 60-year-old male who presented to us with an upper gastrointestinal bleed and was later diagnosed as a case of GIST. CASE DESCRIPTION/METHODS: A 60-year-old male presented to the emergency department with massive upper gastrointestinal bleeding. His initial hemoglobin was 8 g/dl. He was resuscitated with packed red blood cells (RBCs) and high dose proton pump inhibitors. On further inquiry, he stated that he had persistent dyspeptic symptoms for the last 3 months which were not responding to PPI. After hemodynamic stability, endoscopy was performed which showed a large mass in his stomach with an overlying ulcer (Figure 1). Biopsies revealed the mass to be a gastrointestinal stromal tumor (GIST). The patient was counseled that surgery is the only option in his case. However, the patient was not willing for surgery and refused further workup in the form of endoscopic ultrasound. He was lost to follow-up for about 6 months, after which he again had a massive UGIB and ultimately died. DISCUSSION: GIST is a rare pathology and can be categorized into benign or malignant. The presenting symptoms depend on the size and location of the tumor, with some cases tend to remain asymptomatic. The common symptoms include abdominal discomfort, nausea, and vomiting with GIT bleed regarded as a rare occurrence. Different techniques including endoscopy, CT, MRI, and ultrasound are helpful for the initial diagnosis and staging of the tumor but a definite diagnosis can only be made on biopsy. The treatment involves surgery or chemotherapy depending on the stage of tumor. This case signifies an unusual presentation of GIST and highlights the need for early diagnosis and management to reduce mortality in these patients.Figure 1.: Endoscopy showing a large sized mass in stomach with an overlying ulcer characteristic of GIST.

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