Jejunal Gastrointestinal Stromal Tumor Presenting as Recurrent Lower GI Bleeding and Anemia: A Case Report

Abstract

Gastrointestinal stromal tumor (GIST) is the most common type of soft tissue sarcoma found in the gastrointestinal (GI) tract. These tumors originate from the interstitial cells of Cajal (ICC), which regulate GI motility. GISTs account for approximately 1% of all gastrointestinal neoplasms, with the stomach being the most common site (60%). The small intestine is the second most frequent location (20–30%), while the jejunum accounts for only 10%. Rarely, GISTs arise in the colon, rectum, or esophagus. Typically, GISTs affect individuals aged 50–60 years and are often asymptomatic, making diagnosis challenging. In rare cases, jejunal GISTs can present as recurrent lower GI bleeding, posing additional diagnostic difficulties preoperatively. While computed tomography (CT) is the first-line imaging tool for diagnosis, confirmation requires pathological evaluation and immunohistochemistry. The hallmark feature of GIST is the expression of the CD117 antigen, which is 95% specific for these tumors. We report a rare case of jejunal GIST in a 63-year-old male presenting with recurrent lower GI bleeding and anemia for five years. CT imaging revealed a 4.6 × 3.5 cm mass in the proximal jejunum. Initial diagnostic laparoscopy was challenging due to the mass's proximity to the duodenojejunal (D-J) junction. Subsequently, an open exploratory laparotomy was performed, allowing successful excision of the tumor with a 2.5 cm margin on each side. Reconstruction was achieved through a jejunojejunal end- to-end anastomosis. This case highlights the diagnostic and surgical challenges of jejunal GISTs and underscores the importance of a multidisciplinary approach to management.