Chronic GI bleeding in a middle-aged woman

Area of Science:

• Gastroenterology
• Diagnostic Endoscopy
• Surgical Pathology

Background:

• Obscure gastrointestinal bleeding (OGIB) presents a diagnostic challenge, often requiring advanced endoscopic techniques.
• Iron-deficiency anemia can be a presenting symptom of chronic, occult gastrointestinal blood loss.

Observation:

• A middle-aged woman presented with recurrent melena and iron-deficiency anemia.
• Initial investigations including esophagogastroduodenoscopy, colonoscopy, and CT scan were inconclusive.
• Capsule and double-balloon enteroscopy were crucial in identifying the bleeding source.

Findings:

• A 1 cm hemispheric, hard, elevated lesion with an ulcerated surface was identified in the upper jejunum.
• The lesion was consistent with a submucosal tumor (SMT).
• The ulcer on the SMT was presumed to be the source of chronic gastrointestinal bleeding.

Implications:

• Double-balloon enteroscopy is effective in diagnosing and localizing lesions in the small intestine.
• Submucosal tumors of the jejunum should be considered in the differential diagnosis of obscure gastrointestinal bleeding.
• Further investigation and management of the jejunal SMT are warranted.