A283 MASSIVE UPPER GASTROINTESTINAL BLEEDING FROM A JEJUNAL GIST: A CASE REPORT
Bibliographic record
Abstract
Gastrointestinal stromal tumors (GISTs) occur throughout the gastrointestinal tract with about 25 to 30 percent occurring in the jejunum and ileum. About one quarter of these present with overt or obscure gastrointestinal (GI) bleeding. Rarely, GISTS present with massive upper GI bleeding and requiring hospitalization and urgent intervention. To describe a case of massive gastrointestinal hemorrhage from a gastrointestinal stromal tumor with relevant review of the literature. Case presentation was reviewed and review of relevant literature conducted. A 38-year-old male presented to a peripheral hospital with a 1 day history of light headedness and melena. He was noted to be tachycardic at 120 beats per minute with a blood pressure of 147/100. Hemoglobin was initially measured at 123g/L, subsequently dropping to 100g/L 7 hours post initial presentation. He was resuscitated with 2 litres of normal saline and transferred to our center for gastroenterology assessment of upper GI bleeding. On arrival at our center, his heart rate was 98 and blood pressure 134/86. Glasgow-Blatchford Bleeding Score was 12, suggesting a high-risk GI bleed. The patient was placed on a pantoprazole infusion and consented for urgent esophagogastroduodenoscopy (EGD). After stabilization, the patient continued to have melena resulting in a downward trend of hemoglobin concentration to a nadir of 49 g/L. EGD was undertaken and revealed scattered antral erosions but no evidence of active bleeding. The patient was transferred to the intensive care unit and underwent urgent CT angiography. This revealed a nearly 3 cm avidly enhancing mass within the mid jejunum with an appearance most suggestive of a neuroendocrine tumor. The patient continued to have active unstable bleeding and was taken emergently to the operating room for surgical resection. A 3 cm mass was identified in the proximal jejunum, approximately 30 cm from the ligament of treitz. A resection of the jejunal mass and primary anastomosis was undertaken. The patient made an uneventful recovery and was discharged on post-operative day 2. Anatomic pathology revealed a 2.5 by 2.4 by 2.6 cm well circumscribed mass. There was a large blood clot in the small bowel lumen measuring 5.5 cm in length. Histopathologic analysis was consistent with a low grade gastrointestinal stromal tumor. This case illustrates the need to consider rare causes of acute massive gastrointestinal bleeding. Early collaboration with interventional radiology and the surgical team was lifesaving in this case and should be considered in all cases of massive upper GI bleeding. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.005 | 0.003 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.007 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".