A Case of Ileal Vascular Ectasia with Jejunal Gastrointestinal Stromal Tumor which were Diagnosed Accurately by Intraoperative Enteroscopy

Nobuo Kanazawa, Takashi Yoshida, Hideo Mitsui, Doichiro Iizuka, Tomio Arai* and Kojiro Kuroiwa

Department of Surgery and Department of Pathology*, Local Independent Administrative Agency Tokyo Metropolitan Geriatric Hospital

An 84-year-old man with tarry stool and advanced anemia admitted in an emergency was found in upper gastrointestinal endoscopy, colonoscopy, abdominopelvic enhanced computed tomography (CT), and scintigraphy for gastrointestinal hemorrhaging to have, at least two bleeding sites in the ileocecal region and in the left side of the small intestine. Laparotomy identified a submucosal tumor 20 cm distal from the ligament of Treitz. Intraoperative enteroscopy showed a submucosal tumor at the same site and a small erosion 50 cm proximal to the ileocecal valve and flat elevated lesions at the ascending colon. The jejunum was partially resected for the submucosal tumor, and colectomy was done on the right side with ilectomy for the ileal erosion and flat colonic elevations. Histopathological study showed gastrointestinal stromal tumor (GIST) for the jejunal submucosal tumor, vascular ectasia for the ileal erosion, and tubular adenoma for the flat colonic elevations. Bleeding has not recurred. Enteroscopy was the only procedure enabling ileal vascular ectasia to be diagnosed accurately. In a diagnosis of small-intestinal bleeding, we strongly recommend total enteroscopy for the entire small intestine, including intraoperatively, regardless of tumor existence.

Key words
vascular ectasia, GIST, intraoperative enteroscopy

Reprint requests
Nobuo Kanazawa Department of Surgery, Local Independent Administrative Agency Tokyo Metropolitan Geriatric Hospital
35-2 Sakae-cho, Itabashi-ku, 173-0015 JAPAN

Accepted
October 28, 2009

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