Small bowel bleeding is an uncommon cause of gastrointestinal hemorrhage and is often difficult to diagnose when upper and lower endoscopy fail to identify the bleeding source. Dynamic contrast-enhanced computed tomography (DCE-CT) has emerged as an important imaging modality for localizing lesions, estimating the underlying etiology, and guiding treatment strategies. We report two cases of small bowel bleeding with distinct etiologies: Arteriovenous malformation (AVM) and gastrointestinal stromal tumor (GIST). In the first case, DCECT demonstrated a mass-like lesion with intense arterial-phase enhancement comparable to adjacent arteries and early venous drainage, strongly suggesting a vascular lesion. Elective surgical resection was performed, and histopathological examination confirmed AVM. In the second case, CT revealed a well-defined mass with relatively persistent enhancement and contrast extravasation, indicating active bleeding from a neoplastic lesion. Due to hemodynamic deterioration, emergency surgical resection was required, and the lesion was diagnosed as GIST. These cases indicate that systematic evaluation of enhancement patterns and associated CT findings, including early venous drainage and contrast extravasation, can facilitate differentiation between vascular and neoplastic causes of small bowel bleeding and support appropriate treatment selection.

Lower gastrointestinal bleeding (LGIB) is a common emergency, defined nowadays as bleeding of colorectal origin. It predominantly affects elderly patients in whom it is associated with increased morbidity and mortality. The main causes include diverticulosis, anorectal disorders, angiodysplasias, ischemic colitis, post-endoscopic resection complications, and tumor-related bleeding. Clinically, lower gastrointestinal bleeding (LGIB) presents with episodes of hematochezia or melena, or sometimes as occult bleeding. Initial assessment of clinico-biological severity and risk of recurrence is essential to determine the need for hospitalization and the timing of diagnostic procedures. Colonoscopy is the reference diagnostic and therapeutic procedure, ideally performed within 24 hours with CT angiography reserved for cases of hemodynamic instability. In case of failure, therapeutic escalation includes repeat endoscopy, arterial embolization, and, as a last resort, surgery. Early multidisciplinary management helps reduce morbidity, mortality, and recurrence.

Acute gastrointestinal bleeding is a medical emergency in which early management, including pre-hospital care, is crucial for prognosis. The patient's history and clinical examination should focus on identifying signs of severity requiring immediate medical intervention. The pharmalogical treatment of upper gastrointestinal bleeding depends on the suspected cause: proton pump inhibitors for peptic ulcers, splanchnic vasoconstrictors and antibiotics in cases of portal hypertension. Risk stratification using validated scoring systems helps identify low-risk patients eligible for outpatient management. A restrictive transfusion strategy (hemoglobin < 7 g/dL) is recommended. For upper gastrointestinal bleeding, endoscopy should be performed within 24 hours (within 12 hours in patients with portal hypertension). For lower gastrointestinal bleeding, computed tomography angiography is useful for locating active bleeding, while colonoscopy remains the gold standard procedure.

Gastrointestinal bleeding (GIB) is a frequent and potentially life-threatening emergency. It is defined as any bleeding originating from the digestive tract, either overt (hematemesis, hematochezia, melena) or occult. From a nosological perspective, GIB is classified into upper GIB (proximal to the Treitz ligament), lower GIB (colonic or anorectal origin), suspected small bowel bleeding (SSBB), mid-GIB (jejunal or ileal lesions), and obscure GIB (no source identified despite complete evaluation). Over the past 20 years, the incidence of upper GIB has declined by 30-50%, mainly due to Helicobacter pylori eradication, proton pump inhibitors use, and reduced tobacco consumption. Conversely, lower GIB is increasing, and in some countries has surpassed upper GIB in frequency. Hospital mortality has decreased from about 10% to 5-7% owing to advances in diagnostics, therapeutic endoscopy, and healthcare organization. Cirrhotic patients and the elderly remain at particularly high risk.

We report a 55-year-old man who presented with acute small bowel obstruction and hematochezia. He was receiving medications for type 2 diabetes mellitus, chronic renal disease, and ischemic heart disease. Initially, we diagnosed terminal ileitis during colonoscopy. The gastrointestinal bleeding ceased after endotherapy, and the patient underwent surgery for an obstructed internal hernia. Gastrointestinal bleeding recurred on day 5 post-surgery. Mesenteric angiography failed to detect any active bleeding. Histopathological evaluation of the surgical specimen after an ileo-colonic resection led to a diagnosis of Crohn's ileitis.

Intussusception happens when the proximal bowel invaginates into the distal bowel, which can compromise the blood supply and may cause bowel obstruction. Colon intussusception is rare in adults and accounts for only a small proportion of bowel obstructions. Lower gastrointestinal bleeding is rarely caused by this pathology. Intussusception may be idiopathic or the result of underlying benign or malignant pathology. The diagnosis became more reliable with the liberal use of CT. In most cases, it is recommended to respect the involved bowel segment. The patient presented here is a young, otherwise healthy female patient who presented to our hospital with abdominal pain and fresh bleeding per rectum. The CT scan revealed colon intussusception. Laparoscopic left colon resection was performed, and the pathology revealed a submucosal lipoma as the underlying cause.

Introduction Oral anticoagulation is associated with an increased risk of GI bleeding. Proton pump inhibitors (PPIs) are commonly used for gastroprotection but have pharmacologic limitations. This study examined whether vonoprazan is associated with different one-year bleeding and clinical outcomes compared with PPIs among anticoagulated adults. Methods We conducted a retrospective cohort study using the TriNetX database to identify adults receiving oral anticoagulants who initiated vonoprazan or a PPI between 2015 and 2025. Propensity score matching (1:1) was performed to balance demographics, comorbidities, procedures, concomitant medications, and baseline laboratory values. Outcomes were assessed one year after treatment initiation. The primary outcome was GI bleeding; secondary outcomes included all-cause mortality, blood transfusion, and hemoglobin level. Results After matching, 3,107 patients were included in each group. GI bleeding was lower with vonoprazan than with PPIs (55 (1.96%) vs 88 (3.18%); OR 0.61; 95% CI 0.43-0.86). All-cause mortality (177 (5.70%) vs 290 (9.38%); OR 0.58; 95% CI 0.48-0.71) and blood transfusion (≤10 (0.33%) vs 27 (0.88%); OR 0.37; 95% CI 0.18-0.76) were also lower with vonoprazan. Mean hemoglobin at one year was modestly higher with vonoprazan (11.76 ± 2.13 vs 11.54 ± 2.34 g/dL). Conclusions In a propensity-matched real-world anticoagulated cohort, vonoprazan use was associated with lower one-year GI bleeding and transfusion rates, with modestly higher hemoglobin levels, compared with PPIs. These findings are hypothesis-generating and warrant confirmation in prospective studies.

Gastrointestinal (GI) bleeding is a frequent and potentially life-threatening emergency that imposes a substantial healthcare burden worldwide. Over the past three decades, advances in endoscopic technology and technique have transformed management, shifting the emphasis from predominantly diagnostic procedures to targeted, minimally invasive therapeutic interventions across the upper, lower, and small bowel.

This retrospective case-control study aimed to identify risk factors for early (≤6 weeks) and late (>2 years) rebleeding after transjugular intrahepatic portosystemic shunt (TIPS) in cirrhotic patients with acute esophagogastric variceal bleeding (AEVB). A total of 208 consecutive patients who underwent TIPS for AEVB at a single tertiary center between January 2021 and December 2023 were enrolled and followed up until May 2025. Multivariate logistic regression was performed to determine independent predictors of rebleeding at different time points. During follow-up (mean 20.06 ± 9.53 months), 12 patients (5.8%) developed early rebleeding, and 21 (10.1%) had late rebeeding. Multivariate analysis showed that elevated preoperative fasting blood glucose (FBG) was an independent protective factor against early rebleeding (OR = 0.861, 95% CI: 0.765-0.969, P = .013). For late rebleeding, male gender (OR = 3.820, 95% CI: 1.069-13.651, P = .039) and preoperative infection (OR = 6.490, 95% CI: 2.389-17.631, P = .001) were identified as independent risk factors. Higher preoperative FBG is associated with lower risk of early rebleeding after TIPS, whereas male gender and preoperative infection predict an increased risk of late rebleeding. These findings may help risk stratification and perioperative management in patients undergoing TIPS for AEVB.