report of a case with obscure gi bleeding in extramural pedunculated gist

obscure gastrointestinal (gi) bleeding is defined when the source of gi bleeding could not be determined by upper endoscopy, colonoscopy or barium small bowel transit. in this report, a 41 year-old man presented with a history of over ten recurrent episodes of melena since four years prior to admission. the source of bleeding was not detected by multiple upper and lower gi endoscopies. during the last admission, other investigations which included small bowel transit, abdominal radioisotope scan and double balloon enteroscopy up to the mid-jejunum were all inconclusive. for more evaluation, an exploratory laparatomy and intra-operative endoscopy were planned. on laparatomy, a tumoral mass of 7 cm diameter was found on the inferior aspect of the stomach. the tumor was attached to the gastric wall by a 2 cm pedicle and connected into the gastric lumen via a small orifice which was not visible on endoscopic view. the tumor was resected with the surrounding gastric wall. pathologic report favored pedunculated gastrointestinal stromal tumor (gist) and confirmed with the positive cd117 antigen. therefore, in the approach of patients with obscure gi bleeding, rare causes such as extramural pedunculated gist should be considered.