Diagnosis and Treatment of Occult Gi Bleeding After Laparoscopic Roux-en- Y Gastric Bypass (LRYGB). A Case Report of a Gist As Bleeding Source.

Background: Gastrointestinal stromal tumor (GIST) is a rare stromal neoplasm that accounts 5% of all soft tissue sarcomas. It is the most common mesenchymal neoplasm of the gastrointestinal tract. Nearly one third of GISTs are asymptomatic, and even if symptomatic, symptoms are often vague and nonspecific.

Case Presentation: We present a 60-year-old female patient who has been admitted several times to an outside institution due to recurrent episodes of upper GI bleeding. She was referred to our institution for persistent melena with a low hematocrit. The past medical and surgical history was significant for open gastric bypass in 2000. A double balloon enteroscopy was performed and showed diffuse gastric remnant ulceration. A diagnostic laparoscopy with subsequent resection of the gastric remnant was done. She had been stable without any significant sing of bleeding, but then she returned to our institution with hemoglobin of 8mg/dl. She underwent EGD with double balloon, colonoscopy, capsule endoscopy tagged red blood cell scan, and CT angiogram; all of them came back negative. The decision was made to take the patient to the operating room for diagnostic laparoscopy combined with EGD. During manipulation of the small intestine, a tumor was found and resected. Final pathology report gastrointestinal stromal tumor with focal ulceration of the small bowel mucosa.

Conclusion: Diagnostic laparoscopy should be considered in the diagnostic of small bowel bleeding of unknown etiology after gastric bypass.


Session: Video Channel

Program Number: V061

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