A typical presentation of a rare cause of obscure gastrointestinal bleeding

Figure 1 Endoscopic images. A, B: Video-capsule endoscopy detected a jejunal ulceration without bleeding signs. Subsequently, the patient was transferred to our hospital for further diagnostic work-up; C: We performed double-balloon enteroscopy which confirmed the suspected ulcerous lesion.

Figure 2 Biphasic MDCT in the arterial and venous phase. A: Smoothly outlined abdo-minal mass (transverse diameter of about 2.8 cm x 3 cm, long arrow) showing considerable arterial contrast enhancement and intraluminal contrast medium extravasation (shot arrows); B: Washout in the venous phase.

Figure 3 3D volume rendered reconstructions in the arterial phase (A, B). Note that the tumour (arrows) is supplied by vessels from the superior mesenteric and iliac arterial territories.

Figure 4 Surgical specimens. A: Tumor of 3.6 cm × 3.2 cm × 2.8 cm arising from the jejunum (240 cm behind the plica duodenalis superior/ Treitz’s ligament); B:removal of the tumor via a partial jejunal resection; C: sliced preparation of the jejunum with a view of the GIST related ulcer (arrow).

Figure 5 Histological assessment of surgical specimen revealed an ulcerated spindle-celled gastric stromal tumor with well marked margin and a positive staining for CD117 and CD34. A: HE-; B: CD117-; C: CD34-staining.