Jejunal Gastrointestinal Stromal Tumor: A Rare, Elusive, and Formidable Cause of Obscure Bleeding

Gastrointestinal bleeding is classified as obscure in 5% of patients who remain symptomatic after undergoing upper endoscopy, colonoscopy, and small bowel capsule endoscopy. We present a case of a 45-year-old male who had obscure bleeding for eight years and presented with hemorrhagic shock. He was found to have an ulcerated intra-luminal jejunal lesion on enteroscopy, then had surgical resection that revealed a low-risk gastrointestinal stromal tumor (GIST). If GISTs are bleeding, hemostasis should first be achieved with medical, endoscopic, or radiologic interventions, and then resected because they can have malignancy potential. Furthermore, they should be risk-stratified and either surveilled to monitor for recurrence if low risk or need adjuvant imatinib if high risk. There are currently no screening guidelines for GISTs despite their increasing incidences.