A 59-Year-Old Man With Bleeding From a Gastric Polypoid Lesion
A 59-year-old man presented with a 1-week history of vague, abdominal discomfort and dark stools. A sibling had been diagnosed with a gastric mucosa-associated lymphoid tissue (MALT) lymphoma 1 year earlier.
Clinically, the patient was hemodynamically stable but pale; on rectal examination, melena was detected. His hemoglobin level was 106 g/L. The patient was admitted for gastroscopy the following day.
At endoscopy, the stomach was filled with clots, but no bleeding source could be identified. Treatment with intravenous omeprazole was started. Over the next 24 hours, the patient remained stable, but his hemoglobin level dropped to 80 g/L. Repeat gastroscopy showed a 4-cm, broad-based polypoid tumor covered with macroscopically normal mucosa in the fundic region and arterial bleeding from an ulcer on the top (see Figure 1).
(Enlarge Image)
What is your diagnosis and how would you manage this patient?
View the correct answer.
<p>Bleeding gastrointestinal stromal tumor (GIST).</p>
A 59-year-old man presented with a 1-week history of vague, abdominal discomfort and dark stools. A sibling had been diagnosed with a gastric mucosa-associated lymphoid tissue (MALT) lymphoma 1 year earlier.
Clinically, the patient was hemodynamically stable but pale; on rectal examination, melena was detected. His hemoglobin level was 106 g/L. The patient was admitted for gastroscopy the following day.
At endoscopy, the stomach was filled with clots, but no bleeding source could be identified. Treatment with intravenous omeprazole was started. Over the next 24 hours, the patient remained stable, but his hemoglobin level dropped to 80 g/L. Repeat gastroscopy showed a 4-cm, broad-based polypoid tumor covered with macroscopically normal mucosa in the fundic region and arterial bleeding from an ulcer on the top (see Figure 1).
(Enlarge Image)
What is your diagnosis and how would you manage this patient?
Bleeding gastrointestinal stromal tumor (GIST).
View the correct answer.
<p>Bleeding gastrointestinal stromal tumor (GIST).</p>
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