Unusual Gastrointestinal Bleeding due to an Aberrant Artery Neighboring a Jejunal Gastrointestinal Stromal Tumor

Tumor rupture and/or ulceration of the intestinal mucosa are well-known causes of gastrointestinal stromal tumor (GIST) hemorrhage; however, bleeding from an aberrant artery is exceedingly rare. An elderly female presented with profound anemia (nadir Hgb 4.8 g/dL) and ongoing melena over the past week. Esophagogastoduodenoscopy, colonoscopy, and conventional angiography were negative. Tagged red blood cell scintigraphy localized the bleed to the proximal jejunum prompting diagnostic bedside push enteroscopy. Intraoperative examination revealed diverticular bleeding from a large-caliber aberrant artery arising from a shared arterial trunk supplying a jejunal GIST. Histopathology consistent with low-grade combined type GIST with immunochemistry positive for CD117 (c-KIT). This case highlights an unusual presentation of small bowel bleeding originating from an aberrant artery in continuity with a hypervascular jejunal GIST.