A 46-year-old male with no history of interest presented in a routine work review recent onset iron deficiency anemia (Hb 11.3g/dL; MCV 79.8 μ3; Urea 29 mg/dL; Creatinine
The patient denied ingestion of gastro-injury drugs and digestive exteriorization of bleeding, so conventional endoscopic examination (gastroscopy and ileo-colonoscopy) was indicated, which was negative.
After 30 days, the study was completed with an ECE that was also negative. The study was concluded and symptomatic treatment with oral iron supplements was indicated.
At 3 months, the patient came to the emergency department for asthenia and melena in the last 48 hours.
Physical examination was pale and sweaty.
Her blood pressure was 90/60 mm Hg and her heart rate was 105 beats per minute. Her rectal examination revealed melanic stools.
The laboratory analysis of the service (Hb 7 g/dL; VCM 77.2 μ3; Urea 57 mg/dL; Creativity 7 mg/dL) confirmed the suspicion of digestive bleeding, emergency admission for observation.
In the first 24 hours 2,000 ml of fluid therapy were administered and 4 units of fluid replacement were administered. Post-fusion hemoglobin was 9.5 g/dL.
Once the patient was stabilized and when there was suspicion of upper gastrointestinal bleeding, an urgent gastroscopy was negative, repeating a new CES.
In this last exploration, the source of bleeding was identified from a gastric lesion of submucosal origin and ulcerated on its surface that was hidden between the gastric folds.
The definitive diagnosis was obtained after a new gastroscopy and after ruling out metastatic disease, resection was performed.
Histopathological study confirmed the submucosal origin of the lesion (gastric GIST).
