Life-threatening haematochezia in a man with two gastrointestinal stromal tumours

A man in his 30s was brought by ambulance to the emergency department with a complaint of frank bright red rectal bleeding and dizziness. His blood pressure was 60/18 mm Hg. He was resuscitated with intravenous normal saline and an emergency blood transfusion. Following a negative emergency oesophagogastroduodenoscopy and colonoscopy, an angiographic CT of the abdomen revealed a large tumour in the ileum. After failing to stabilise him with multiple blood transfusions, he had an emergent laparotomy and surgical resection of the tumour, which was confirmed by histocytology as gastrointestinal stromal tumour (GIST). He made full recovery and was discharged home after 10 days. We discussed the challenges of managing significant lower gastrointestinal bleeding and reviewed the current management of GIST.