Acute gastrointestinal bleeding: What is the next step after endoscopy? A case report

Öz

Gastrointestinal stromal tumors are among the rare causes of gastrointestinal system bleeding. These tumors are the most common mesenchymal neoplasms of the gastrointestinal tract. When located in the small intestine, they may be difficult to detect by upper gastrointestinal endoscopy and colonoscopy. Various non-invasive and invasive imaging techniques have been employed to detect these small bowel tumors. One of these methods includes magnetic resonance enterography. In this study, we have presented a 62-year-old male patient who was admitted to the emergency department with the complaint of melena. Because no causative factor for bleeding was detected by endoscopic imaging and erythrocyte-labeled scintigraphy, magnetic resonance enterography was performed. A mass of soft tissue density was detected at the jejunum-ileum junction. The pathology of the surgically removed mass was gastrointestinal stromal tumor. After the operation, the patient was discharged with full recovery. Endoscopic methods are the first-line methods in diagnosis and treatment of gastrointestinal system bleeding. In cases where endoscopic procedures are insufficient, non-invasive tools can be used. Magnetic resonance enterography, which is a non-invasive method, should therefore be considered in gastrointestinal system bleedings when the source of bleeding cannot be detected by endoscopic methods.

Anahtar Kelimeler

• Gastrointestinal stromal tumor
• magnetic resonance enterography
• gastrointestinal system bleeding

Akut gastrointestinal sistem kanması: Endoskopi sonrası sırada ne var? Olgu sunumu

Öz

Gastrointestinal sistem kanamalarının nadir sebepleri arasında gastrointestinal stromal tümörler vardır. Bu tümörler, gastrointestinal sistemin en sık görülen mezenkimal neoplazmlarıdır. İnce barsak yerleşimli olduklarında üst gastrointestinal sistem endoskopide ve kolonoskopide saptanması güç olabilir. İnce barsak yerleşimli bu tümörleri saptamak için çeşitli non-invaziv ve invaziv görüntüleme yöntemleri kullanılır. Bu yöntemlerden biri de manyetik rezonans enterografidir. Bu yazımızda acil servise melena şikayetiyle gelen 62 yaşında erkek hastamızı sunuyoruz. Endoskopik görüntülemelerde ve eritrosit işaretli sintigrafide kanama odağı ve kanamaya sebep olan patolojinin saptanamaması üzerine yapılan manyetik rezonans enterografide jejunum-ileum bileşkesinde yumuşak doku intensitesinde kitleye rastlandı. Operasyonla çıkarılan kitlenin patolojisi gastrointestinal stromal tümör olarak geldi. Operasyon sonrası hasta şifa ile taburcu edildi. Gastrointestinal sistem kanamalarında tanı ve tedavide endoskopik yöntemler ilk başvurulan araçlardır. Endoskopik işlemlerin yetersiz kaldığı durumlarda invasiv araçlara başvurulabilir. Bu araçlara başvurmadan, endoskopik yöntemlerle nedeni saptanamayan gastrointestinal sistem kanamalarda non-invasiv bir yöntem olan manyetik rezonans enterografi akla gelmelidir.

Anahtar Kelimeler

• Gastrointestinal stromal tümör
• manyetik rezonans enterografi
• gastrointestinal sistem kanaması

Kaynakça

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