Author Affiliations:Surgical Department (Drs Fischer and Metzger), and Department of Pathology (Dr Nagel), Cantonal Hospital Lucerne, Lucerne, Switzerland.
A previously healthy 48-year-old woman was admitted to the hospital with acute hematemesis and melena. A physical examination revealed that she was in good general health without any abdominal tenderness or pain on palpation and normal bowel sounds. Her vital signs showed a slightly reduced blood pressure (120/70 mm Hg) with tachycardia of 110 beats/min. Within a few hours, her hemoglobin concentration rapidly dropped from 111 g/L to 85 g/L and further to 74 g/L even after she received 2 red blood cell transfusions. An esophagogastroduodenoscopy did not show any bleeding lesions in the upper gastrointestinal (GI) system. Computed tomography finally revealed a round mass in the patient's left upper abdomen, probably in the jejunum. Because of her persistent anemic bleeding, the patient was taken to the operating room. Performing an explorative laparotomy, we found a large vascularized tumor 8 × 5 × 6 cm located 20 cm distal from the musculus suspensorius duodeni (Figure 1and Figure 2). We performed a segmental resection of the small bowel with excision of the palpable lymph nodes. Recovery in the patient was uneventful.
Hypervascularized tumor located 20 cm distal from the duodenojejunal flexure.
Macroscopic findings after resection and incision of the tumor and the small bowel (found inside the erosion).
B. Adenocarcinoma of the small bowel
C. Gastrointestinal stromal tumor
D. Bleeding of the Meckel diverticulum
Thank you for submitting a comment on this article. It will be reviewed by JAMA Surgery editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
The Rational Clinical Examination
What Adverse Events Can Result From a Paracentesis?
All results at
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.