Hematochezia Due to Rare Small Bowel Lesions

Aims: Small bowel lesions are important differentials in patients presenting with hematochezia and these two cases highlight the clinical challenges in diagnosis and management of such cases.

Presentation of Cases: Both of the patients present with fresh per rectal bleeding with variable degrees of hemorrhagic shock with no or minimal preceding symptoms like abdominal pain. Imaging was beneficial in accurately localizing the lesion in 1st patient and histologically gastrointestinal stromal tumour [GIST] was diagnosed. 2nd case illustrates the limitations of conventional endoscopy and unavoidable delays in decision making that can happen with small bowel lesions in a patient eventually found to have rare jejunal diverticula.

Conclusions: Small bowel lesions are rare and carry significant morbidity and mortality. They are difficult to diagnose and even with advance imaging and endoscopic facilities some cases can still be undiagnosed.