Laparoscopic excision of proximal ileal GIST presenting with massive upper GI bleeding: a case report

Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors of the gastrointestinal (GI) tract, most commonly arising in the stomach. Ileal GISTs are uncommon, and presentation with upper GI bleeding is exceptionally rare, posing a diagnostic challenge.

We report a case of a 60-year-old woman presenting with hematemesis, melena, and severe anemia. After initial stabilization, upper GI endoscopy failed to identify the source of bleeding. Contrast-enhanced computed tomography revealed a heterogeneously enhancing mass in the proximal ileum. Laparoscopic-assisted resection of the ileal segment with end-to-end anastomosis was performed. Histopathology confirmed GIST, positive for c-kit and DOG1. The postoperative period was uneventful, and the patient remained symptom-free at 1-month follow-up.

Ileal GISTs presenting with acute upper GI bleeding are rare and often missed on routine endoscopy, highlighting the importance of imaging for diagnosis. Complete surgical excision with negative margins remains the standard treatment. Minimally invasive laparoscopic resection is safe, feasible, and effective. Adjuvant tyrosine kinase inhibitors, such as imatinib, are reserved for high-risk lesions or unresectable tumors.

This case highlights the importance of considering GIST as a differential diagnosis in obscure upper GI bleeding. It also demonstrates that laparoscopic resection is a safe and effective treatment option for ileal GISTs, even in the context of acute bleeding.