From Dieulafoy's Lesion to Gastrointestinal Stromal Tumor: A Case of Recurrent Upper Gastrointestinal Bleeding.

Dieulafoy's lesion and gastrointestinal stromal tumors (GISTs) are uncommon causes of upper gastrointestinal (GI) bleeding. We report a rare case of recurrent upper GI bleeding in a 71-year-old male who initially presented in 2017 with hematemesis, melena, and hemodynamic instability. Upper GI endoscopy identified a fundal Dieulafoy's lesion, which was successfully treated with endoscopic clipping. Seven years later, the patient re-presented with melena, fatigue, dizziness, and symptomatic anemia requiring blood transfusion. Repeat endoscopy demonstrated a 6-cm ulcerated submucosal mass in the gastric fundus. Endoscopic ultrasound showed a lesion arising from the fourth layer of the gastric wall, and fine-needle aspiration confirmed a low-grade mixed-type GIST. Computed tomography demonstrated a localized enhancing gastric mass without evidence of metastatic disease. Following multidisciplinary review, the patient underwent successful laparoscopic wedge resection. Histopathological examination confirmed a completely excised low-risk gastric GIST measuring 6.5 × 5.5 × 4.5 cm with a mitotic rate of 3 mitoses per 5 mm² and negative surgical margins. The postoperative course was uneventful. This case highlights the importance of reassessing patients with recurrent GI bleeding despite a previously identified bleeding source. The unusual temporal association between a Dieulafoy's lesion and a subsequently diagnosed gastric GIST in the same anatomical region underscores the need for continued diagnostic vigilance and multidisciplinary management in atypical presentations of upper GI bleeding.