Jejunal Gastrointestinal Stromal tumor (GIST) (9 of 86)

In as many as 5% of patients with obscure GI bleeding, a
source cannot be identified despite extensive examination.
When a lesion cannot be identified after standard upper
endoscopy and colonoscopy, further evaluation depends on
the briskness of bleeding (see algorithm). In those with
active (brisk) bleeding, technetium-99 radionuclide
scanning or angiography should be performed. In patients
with a subacute presentation (or intermittent bleeding), the
focus of investigation should be broadened to include the
small intestine. The lesions most commonly identified as
bleeding sites in the small bowel include tumors and
vascular ectasias, which vary in frequency depending on
age. In patients between 30 and 50 years of age, tumors
are the most common abnormalities, whereas in patients
less than 25 years of age, Meckel diverticula are the most
common source of small bowel bleeding. Vascular ectasias
predominate in older patients. Other rare causes in the
differential diagnosis of obscure GI hemorrhage include
hemosuccus pancreaticus, hemobilia, aortoenteric fistula,
Dieulafoy lesion, extraesophageal varices, and diverticula
(especially of the small intestine).