RESUMO
A 39-year-old woman with no known risk factors presented for a recurrent upper gastrointestinal (GI) bleed. She had a prior history of failed kidney and pancreatic transplants secondary to childhood diabetes mellitus type I. After an extensive workup, she was found to have active hemorrhage into an area of the small bowel from an artery supplying her failed pancreatic transplant. Here, we discuss the importance of a systematic approach to evaluation, a high index of suspicion, and a known but not entirely common method of treatment for this condition.
RESUMO
INTRODUCTION: In a minority of patients with gastrointestinal bleeding, the offending lesion is not able to be identified using colonoscopy or esophagogastroduodenoscopy (EGD). For these patients, video capsule endoscopy has become a cornerstone for the diagnosis of gastrointestinal bleeding in the territory not accessible by colonoscopy or EGD. One uncommon cause of bleeding from the small bowel is a gastrointestinal stromal tumor. CASE PRESENTATION: We present the case of a 76-year-old man who presented with 2 weeks of melena that began after starting dual antiplatelet therapy with aspirin and clopidogrel after undergoing coronary artery stenting. After EGD and colonoscopy failed to identify the culprit, the patient underwent video capsule endoscopy, which identified a suspicious area concerning for intussusception. Computed tomography enterography was then performed and showed a short segment of bowel wall thickening. The patient underwent laparoscopic small bowel resection and was found to have a gastrointestinal stromal tumor.