Document Type : Case Report


Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran


Objective: Gastrointestinal bleeding is one of the surgical emergencies that is routinely
visited in emergency departments. Although most of these patients are managed with
endoscopic modalities, some of them are managed with surgical interventions. Most of
emergency surgical interventions are done via laparotomy. With evolution in minimal
invasive surgery, the role of laparoscopic surgeries in emergency settings is on a rise.
Case Presentation: In this report we describe a case of lower gastrointestinal bleeding
that was presented with melena and during workups no bleeding lesion was detected
in colon, stomach or duodenum. Further investigations revealed bleeding of proximal
jejunum mass that was resected with the laparoscopic approach which is rarely used in
the emergency management of patients with gastrointestinal bleedings. Also, resection
and anastomosis of proximal jejunal loop was challenging in this case.
Conclusion: This report is intended to describe the feasibility of laparoscopy in proximal
small bowel lesion resection in emergency settings as well as the role of CT angiography in
detecting the source of obscure gastrointestinal bleeding


Main Subjects

1. Bianchi M, De Pascalis B, Koch M. Jejunal GIST: an unusual cause of gastrointestinal bleeding. Dig Liver Dis. 2010; 42(10):744. doi: 10.1016/j.dld.2009.06.008.
2. Dualim DM, Loo GH, Rajan R, Nik Mahmood NRK. Jejunal GIST: hunting down an unusual cause of gastrointestinal bleed using double balloon enteroscopy. A case report. Int J Surg Case Rep. 2019; 60: 303-6. doi:10.1016/j.ijscr.2019.06.053.
3. Nakatsu S, Yasuda H, Maehata T, Nomoto M, Ohinata N,Hosoya K, et al. Urgent computed tomography for determining the optimal timing of colonoscopy in patients with acute lower gastrointestinal bleeding. Intern Med. 2015; 54(6): 553-8. doi:10.2169/internalmedicine.54.2829.
4. Morrison JE, Hodgdon IA. Laparoscopic management of obstructing small bowel GIST tumor. Jsls. 2013; 17(4): 645-50.doi: 10.4293/108680813x13x13794522667445.
5. Iacob R, Dimitriu A, Stanciulea O, Herlea V, Popescu I, Gheorghe C. Enteroscopic tattooing for better intraoperative
localization of a bleeding jejunal GIST facilitates minimally invasive laparoscopically-assisted surgery. J Gastrointestin Liver Dis. 2016; 25(1): 105-8. doi: 10.15403/jgld.2014.1121.251.gst.
6. Daldoul S, Moussi A, Triki W, Baraket RB, Zaouche A. Jejunal GIST causing acute massive gastrointestinal bleeding: role of multidetector row helical CT in the preoperative diagnosis and management. Arab J Gastroenterol. 2012; 13(3): 153-7. doi:10.1016/j.ajg.2012.08.005.
7. Pitiakoudis M, Zezos P, Courcoutsakis N, Papanas N, Giatromanolaki A, Sivridis E, et al. Is laparoscopic resection
the appropriate management of a jejunal gastrointestinal stromal tumor (GIST)? Report of a case. Surg Laparosc
Endosc Percutan Tech. 2010; 20(5): e160-3. doi: 10.1097/SLE.0b013e3181f334ca.