Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, yet it remains a diagnostic challenge in adults due to its non-specific presentation and lower prevalence compared to the pediatric population. We report the case of a 61-year-old man with a history of rectosigmoid adenocarcinoma who presented with recurrent, life-threatening hematochezia from a diverting loop ileostomy. After inconclusive endoscopic and computed tomography (CT) evaluations, mesenteric angiography identified an aberrant omphalomesenteric (vitelline) artery supplying an MD. Following coil embolization for acute hemostasis and subsequent nuclear medicine confirmation, the patient underwent successful surgical resection. This case underscores the importance of maintaining a high index of suspicion for MD in adults with obscure gastrointestinal bleeding.

Gastrointestinal (GI) bleeding is a relatively common presenting complaint in pediatric practices and may arise from either the upper or lower GI tract. Many common causes of GI bleed are benign and self-limited, often requiring only supportive care with no imaging necessary. When indicated, the goal of imaging is to diagnose and localize the source of bleeding to help guide timely, targeted interventions. Abdominal radiography is often the initial imaging study obtained for patients presenting with GI bleeding. Although it is usually unable to precisely localize the site of bleeding, it may provide clues to the diagnosis. Nuclear medicine imaging studies including pertechnetate (Meckel scan) and tagged red blood cell studies can help localize the site of bleeding, occasionally providing a specific diagnosis. CT angiography of the abdomen and pelvis may be appropriate in many scenarios; however, in unstable patients CT angiography is usually appropriate as initial imaging. Visceral angiography may also be used. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Colonic varices are a rare manifestation of portal hypertension and an uncommon cause of lower gastrointestinal bleeding, particularly when involving the proximal colon. We report a case of bleeding hepatic flexure varices in a 23-year-old male with extrahepatic portal vein obstruction (EHPVO) and prior splenectomy with lienorenal shunt. The patient presented with recurrent hematochezia and severe anemia. Upper gastrointestinal endoscopy was negative for a bleeding source, while colonoscopy revealed large tortuous varices at the hepatic flexure with stigmata of recent hemorrhage. Contrast-enhanced CT confirmed cavernomatous transformation of the portal vein with extensive mesenteric collaterals, thrombosis of the prior shunt, and afferents to the varix arising from the superior mesenteric vein. Endoscopic therapy was performed using clip-assisted flow modulation of the afferent and efferent venous channels, followed by N-butyl-2-cyanoacrylate injection into the main variceal trunk. The procedure resulted in successful obliteration of the varices without complications, with no further bleeding on follow-up. This case highlights hepatic flexure varices as a rare cause of lower gastrointestinal bleeding in EHPVO and demonstrates the feasibility of clip-assisted cyanoacrylate injection as an effective endoscopic treatment strategy for high-flow colonic varices.

Bean syndrome, also known as blue rubber bleb nevus syndrome, is a rare congenital disorder characterized by multiple venous malformations affecting the skin, soft tissues, and gastrointestinal tract. Its main complication is chronic gastrointestinal bleeding, which can lead to iron-deficiency anemia and a lower quality of life. We present the case of a pediatric patient diagnosed with Bean syndrome, in whom typical skin lesions and gastrointestinal involvement were identified. We describe the clinical course, the diagnostic tests performed, and the treatment regimen initiated with sirolimus. This case highlights the importance of recognizing this condition in children for early diagnosis and timely treatment, as well as the need for multidisciplinary follow-up. Sirolimus represents a promising therapeutic option for severe cases, although it requires close monitoring.

Acute hemorrhagic rectal ulcer (AHRU) is an uncommon but clinically significant cause of lower gastrointestinal bleeding in critically ill patients. While stress-related mucosal disease is a well-recognized cause of upper gastrointestinal bleeding in the intensive care unit (ICU), ischemic injury involving the rectum is less frequently reported. Patients recovering from septic shock, particularly those requiring prolonged vasopressor therapy, remain at risk for delayed ischemic complications. We present a case of delayed severe lower gastrointestinal bleeding due to AHRU following septic shock, highlighting the risk of ischemic complications even after apparent clinical stabilization. A 54-year-old man with insulin-dependent type 2 diabetes mellitus presented with severe diabetic ketoacidosis and was admitted to the ICU. His course was complicated by methicillin-sensitive Staphylococcus aureus pneumonia and septic shock requiring prolonged vasopressor support. After initial clinical improvement and transfer out of the ICU, he developed acute hematochezia with a significant decline in hemoglobin. Computed tomography angiography demonstrated active rectal bleeding. Flexible sigmoidoscopy revealed multiple rectal ulcers consistent with AHRU. Although hematin and ulcerated mucosa with stigmata of recent bleeding were identified in the rectosigmoid region, the ulcers were not actively bleeding at the time of the procedure, and no endoscopic hemostatic intervention was performed; lavage was performed to improve visualization. His condition deteriorated with hemorrhagic shock requiring reintubation, vasopressor support, and massive transfusion protocol. Following multidisciplinary management, he stabilized and was ultimately discharged to a rehabilitation facility. This case is notable for the delayed onset of severe lower gastrointestinal bleeding due to AHRU following apparent recovery from septic shock, highlighting a temporal gap between hemodynamic insult and clinical manifestation. Unlike typical stress-related mucosal disease, which primarily affects the upper gastrointestinal tract, AHRU represents a less recognized form of ischemic injury involving the rectum, likely driven by prolonged splanchnic hypoperfusion and vasopressor-induced vasoconstriction. The severity of bleeding requiring massive transfusion and critical care re-escalation underscores the potential for rapid clinical deterioration. This case emphasizes the importance of maintaining a high index of suspicion for ischemic rectal injury in post-ICU patients with new-onset hematochezia, even after initial stabilization. This case highlights a rare and delayed ischemic complication of septic shock. AHRU should be considered in critically ill patients with new-onset lower gastrointestinal bleeding, particularly following prolonged vasopressor use. Current stress ulcer prophylaxis strategies may not prevent such complications, emphasizing the need for broader preventive approaches targeting splanchnic perfusion, bowel care, minimization of prolonged rectal device use, and early recognition of ischemic lower gastrointestinal injury.

Schistosomiasis is a neglected tropical disease with clinical presentations that vary depending on the species involved. Schistosomal colitis is a rare manifestation, with few cases documented in the literature. We report a case of a 9-year-old boy presenting with painless hematochezia and a history of residence in a schistosomiasis-endemic region. Colonoscopy revealed evidence of colitis, and histopathological examination of colon biopsy confirmed schistosomal ova with eosinophilic infiltration in the colonic mucosa. The patient responded well to treatment with oral Praziquantel (40 mg/kg). This case underscores the need for a high index of suspicion and the inclusion of tropical diseases in the differential diagnosis when evaluating patients with lower gastrointestinal bleeding, particularly in endemic areas. Pediatric schistosomal colitis in Africa represents a clinically significant yet often underdiagnosed manifestation of Schistosomiasis, highlighting the need for heightened awareness of its distinctive gastrointestinal presentations, diagnostic challenges, and implications for early intervention in children living in endemic regions.

In this study, we aimed to evaluate the outcomes of early enteral feeding among very low birth weight (VLBW) infants. We searched PubMed, the Cochrane Library, Scopus, and Web of Science up to October 2025. The intervention group was identified from randomized controlled trials (RCTs) wherein feeding was started early (≤72 h), and those with delayed initiation served as controls. Meta-analysis was performed using RevMan 5.4 software. Seventeen RCTs were included in the meta-analysis. Early feeding did not significantly increase the risk of mortality (risk ratio [RR] = 0.72; 95% confidence interval [CI]: 0.51 to 1.01) or necrotizing enterocolitis (NEC; RR = 1.02; 95% CI: 0.76 to 1.37). It was associated with a significant reduction in the incidence of sepsis (RR = 0.78; 95% CI: 0.61 to 0.98), shortening in the time to full enteral feeding (mean difference [MD] = -2.72 days; 95% CI: -5.08 to -0.36), and a borderline reduction in the duration of hospitalization (MD = -4.54 days; 95% CI: -8.86 to -0.04). No significant differences were found in the incidence of intraventricular hemorrhage (IVH), gastrointestinal bleeding, bronchopulmonary dysplasia, and feeding intolerance as well as weight gain. Subgroup analyses indicated shorter durations of hospitalization with feeding after 48 h and lower IVH rates in studies published after 2000, while other outcomes showed no significant differences. Early enteral feeding in VLBW infants did not increase major adverse outcomes and may provide modest benefits, such as shorter time to full enteral feeding, without significantly affecting NEC, or IVH rates. On the basis of the available RCT data, early feeding did not show evidence of increased harm. However, given the substantial heterogeneity and variability across studies, these findings should be interpreted with caution. More high-quality trials are needed to optimize timing and feeding protocols.