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156 AN UNUSUAL FINDING IN A PATIENT WITH HEMATEMESIS: A CASE REPORT CP White1, C Soornahalli2, JS McGrath3 A 59 year old off shore fisherman presented to the emergency room with complaints of frank hematemesis and having an episode of syncope while at sea. On physical examination he was tachycardic and initial blood work revealed an anemia. After stabilization in the Emergency Room (ER) and Gastrointestinal (GI) consultation, it was arranged for the patient to undergo esophagogastroduodenoscopy. The procedure revealed an actively bleeding submucosal lesion on the greater curvature of the stomach. Hemostasis was achieved with injection of epinephrine and heater probe coagulation; but since there was a mass lesion associated with the bleeding source, a surgical opinion was obtained.
1Faculty of Medicine, Memorial University of Newfoundland; 2Department of Pathology, Faculty of Medicine, Memorial University of Newfoundland; 3Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland
Laparotomy was performed which showed an obvious lesion on the greater curvature of the stomach. A gastric wedge resection of this mass was performed. Formal pathology on the resected specimen showed a 4 x 2.5 x 3 cm mass consistent with a gastrointestinal stromal tumour (GIST). The mucosal surface of the mass showed an ulcer measuring 1.1 cm, which was the cause of the hematemesis and the acute presentation.
It is atypical for the presentation of a GI bleed to result in the finding of a GIST. These tumours are relatively rare and therefore are not often encountered by surgeons and GI physicians. An actively bleeding GIST has not been visually documented by literature reviews or case reports. The clinical presentation of this patient and the underlying pathology is rare but suggests that a GIST should be considered as a rare cause of an upper GI bleed.