A Case of Bleeding from Proximal Jejunal GIST Diagnosed by Colonoscopy through the Oral Approach / 대한소화기내시경학회지

Gastrointestinal bleeding from small bowel lesions is uncommon but it is the most common cause of obscure gastrointestinal bleeding that can go undiagnosed using traditional upper endoscopy and colonoscopy. Recently, various new methods, including wireless capsule endoscopy and double-balloon enteroscopy have been used to detect and manage small bowel lesions. A 51-year-old man was admitted with hematochezia. The source of bleeding could not be identified using conventional upper endoscopy and colonoscopy. Wireless capsule endoscopy revealed a mass-like lesion with active blood spurting in the proximal jejunum. Finally, a tumor with central ulceration was detected at the proximal jejunum using a clean colonoscope through the oral approach. This lesion was surgically resected, and the histology findings were consistent with a gastrointestinal stromal tumor. We report a case of gastrointestinal bleeding from a proximal jejunal GIST diagnosed by clean colonoscopy through the oral approach with a review of the relevant literature.

A Case of Adenomyoma Causing Jejunal Bleeding / 대한소화기내시경학회지

Adenomyoma, a benign tumor generally considered to be a form of pancreatic heterotopia, is composed of smooth muscle and undifferentiated columnar epithelium. A 62-year-old female was admitted with melena. Small bowel enteroscopy using a pediatric colonoscope revealed a small sized nodular mass with active bleeding in the proximal jejunum. After a endoscopic resection of the tumor, the bleeding ceased. Histologic examination disclosed an adenomyoma. We report a case of the adenom-yoma causing jejunal bleeding with a review of the literature.

A Case of Inflammatory Fibroid Polyp Presenting with Jejunal Bleeding / 대한소화기학회지

Inflammatory fibroid polyp occurs very rarely in the jejunum and gastrointestinal bleeding as an initial manifestation of inflammatory fibroid polyp has not been reported. We report a case of a jejunal inflammatory fibroid polyp presenting with melena for 10 days. Upper gastrointestinal endoscopic examination was negative for any active bleeding lesions and abdominal angiography failed to localize the bleeding site as well. In contrast, computed tomography of the abdomen demonstrated a segmental wall thickening of the jejunum with a tumor-like mass lesion associated with dense contrast enhancement. Consistent with this, technetium 99m red blood cells scintigraphy exhibited red cell pooling at the right upper quadrant. On exploratory laparotomy, there was an active bleeding from the site of the jejunal tumor and a segmental resection was performed. Histologically, the tumor lesion of the jejunum was consistent with inflammatory fibroid polyp. Thus, we conclude that the tumor lesion was a cause of the gastrointestinal bleeding.