Introduction

Gastrointestinal (GI) bleeding is a common yet potentially life-threatening medical emergency, caused by a variety of pathologies ranging from benign disorders like peptic ulcers to more complicated ones, including tumors and vascular abnormalities [1]. While most cases are attributable to common etiologies, uncommon causes such as Dieulafoy’s lesion and gastrointestinal stromal tumors (GISTs) present significant diagnostic challenges due to their variable and often atypical clinical presentations [2].

Dieulafoy’s lesion is a rare but significant cause of upper GI bleeding, caused by a large submucosal artery protruding through intact mucosa, typically in the stomach. Although it accounts for only 1-5% of upper GI bleeds, it can lead to severe, potentially life-threatening hemorrhage [1]. Diagnosis can be challenging due to intermittent bleeding and the possibility of missed lesions during initial endoscopic evaluation. Endoscopic identification and treatment may require careful evaluation and, in some cases, repeated procedures using therapeutic modalities such as clipping, injection therapy, or thermal coagulation [3]. GISTs are rare mesenchymal neoplasms arising from the interstitial cells of Cajal within the GI tract. They occur most frequently in the stomach (60-70%) and small intestine (25-35%). Although many GISTs are detected incidentally, approximately 70% of patients are symptomatic at diagnosis, commonly presenting with GI bleeding secondary to mucosal ulceration or tumor erosion. The liver and peritoneum are the most frequent sites of metastatic disease, while lymphatic spread is uncommon. Evaluation for metastatic or synchronous lesions is therefore an important component of staging and treatment planning [2,4].

While both Dieulafoy’s lesion and GISTs are independently uncommon causes of upper GI bleeding, their coexistence or sequential occurrence has rarely been described in the literature [2]. Current published literature includes only a small number of case reports describing GISTs associated with Dieulafoy-like vascular lesions or prominent tumor-associated vessels presenting with GI hemorrhage. These reports highlight the diagnostic challenges posed by these uncommon entities and emphasize the importance of maintaining a broad differential diagnosis in patients with recurrent bleeding [2,5-8]. Furthermore, previous studies have demonstrated that repeat esophagogastroduodenoscopy and colonoscopy may improve the diagnostic yield in patients with persistent or recurrent GI bleeding when initial investigations fail to identify the underlying source [5].

We report a unique case of a patient who initially presented with upper GI bleeding secondary to a Dieulafoy’s lesion and experienced recurrent bleeding seven years later due to a gastric GIST arising in the same anatomical region. This case highlights the importance of considering uncommon etiologies in patients with recurrent GI bleeding and emphasizes the value of repeated evaluation and multimodal diagnostic approaches when symptoms recur.