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Adewale A. Musa, Adekunbiola F. Banjo, Olufemi T. Oladapo, Ayodeji O. Agboola, Jabez A. Akindipe, Idris A. Okewole
CaseRepClinPractRev 2006; 7:224-227
Background: Gastrointestinal (GI) bleeding is a symptom of a wide range of clinical disorders some of which are primarily not related to the gastrointestinal tract. This report highlights the diagnostic challenges encountered in the management of a case of metastatic choriocarcinoma that presented with features of upper GI bleeding.
Case Report: A 28-year old Para 1[sup]+1[/sup] woman presented at the Gynecological Emergency Unit of a tertiary health facility in Nigeria with a 3-month history of amenorrhoea and generalized body weakness of one week duration. Her past medical history was notable for a uterine evacuation that she had four
years earlier on the suspicion of hydatidiform mole. Investigations showed a hematocrit of 09% and
positive urinary pregnancy tests. She had an emergency pelvic exploration on a strong suspicion
of ruptured ectopic pregnancy. Operative findings, however, showed grossly normal and intact
reproductive tract. Her rapidly declining hematocrit in spite of blood transfusions and passage
of tarry stool in the following week postoperative necessitated a referral to the General Surgery
Unit with a provisional diagnosis of upper GI bleeding possibly from chronic duodenal ulcer.
However, this diagnosis was excluded by an emergency esophago-duodenoscopy at the surgical unit. Her deteriorating clinical condition necessitated a surgical abdominal re-exploration that showed hemorrhagic jejunal tumors and an ileo-ileal intussusception. Histological examination
of the excised specimen showed features in keeping with metastatic choriocarcinoma. Her clinical
condition improved on chemotherapy and has remained satisfactory on follow-up.
Conclusions: Diagnosis of metastatic choriocarcinoma of the small bowel requires a high index of suspicion and a multidisciplinary approach to its management in order to reduce the risk of severe morbidity
and mortality. Prompt surgical intervention by laparotomy may be life-saving in situations where
the source of bleeding cannot be readily ascertained either as a result of diagnostic obscurity
or limitations in diagnostic facilities.