Background: Inferior vena cava (IVC) graft-enteric fistula is an exceptionally rare but potentially fatal complication of caval reconstruction. Case Presentation: A 22-year-old woman with previous IVC and right renal vein reconstruction presented with an 18-month history of intermittent abdominal pain, diarrhea, and progressive anemia. On admission, contrast-enhanced computed tomography demonstrated a thrombosed IVC graft with perigraft gas and fluid, loss of the fat plane between the graft and adjacent bowel, and a multiloculated right psoas abscess. Escherichia coli was isolated from blood and drainage cultures. Upper gastrointestinal endoscopy directly visualized prosthetic graft material protruding into the descending duodenum, confirming a graft-enteric fistula. After targeted antimicrobial therapy and stabilization, the patient underwent complete graft explantation, resection of the involved duodenal and jejunal segments, duodenojejunal reconstruction, and extensive retroperitoneal debridement. She remained free of recurrent infection, fistula, and gastrointestinal bleeding at 5-year follow-up. Conclusions: In patients with previous caval reconstruction, persistent gastrointestinal symptoms, unexplained anemia, bacteremia, or retroperitoneal infection should raise suspicion for a graft-enteric fistula. Computed tomography may identify suggestive perigraft changes, whereas endoscopy can provide direct confirmation of luminal erosion.

There are various radiopharmaceuticals and hybrid imaging techniques for evaluating pediatric patients in the acute care setting. The focus of this article is on common nuclear medicine applications in pediatric acute care. Brain scintigraphy is an important ancillary test for evaluation of brain death/death by neurologic criteria when the clinical examination or apnea test cannot be safely or completely performed. Ventilation-perfusion scintigraphy is considered as a safe and useful test for suspected pulmonary embolism in hemodynamically stable children, especially when the chest radiograph is normal or near normal and radiation reduction is important. 99mTc-pertechnetate scintigraphy is stated to be the best noninvasive nuclear medicine test for detecting ectopic gastric mucosa in Meckel's diverticulum, whereas 99mTc-labeled red blood cell scintigraphy is useful for evaluating active or intermittent lower gastrointestinal bleeding from different causes. Hepatobiliary scintigraphy provides functional assessment of biliary excretion and is useful for evaluation of acute cholecystitis, choledochal cysts, and bile leaks. 99mTc-DMSA renal cortical scintigraphy is a sensitive method for detecting acute pyelonephritis and renal cortical scarring, while 99mTc-MAG3 renal scintigraphy is used to evaluate early and late complications of renal transplantation. Bone scintigraphy is considered as a valuable imaging modality for evaluation of osteomyelitis, occult fracture, stress injury, sickle cell related bone pain, and selected cases of suspected physical abuse, especially when whole body assessment is needed. 18F-FDG PET/CT has an increasing role in selected children with fever of unknown origin and inflammatory disorders. Moving forward, continued refinement of pediatric administered activities, wider use of SPECT/CT and PET-based imaging and updated pediatric-specific guidelines are expected to further improve the role of nuclear medicine in acute pediatric care.

Anemia is a nearly universal complication of chronic kidney disease (CKD). While erythropoiesis-stimulating agents (ESAs) are the standard of care, they rarely induce acquired pure red cell aplasia (PRCA) via neutralizing anti-erythropoietin (anti-EPO) antibodies. Diagnosis is often delayed as clinical focus frequently shifts toward more common causes of acute anemia, such as hemorrhage. An 88-year-old male on maintenance hemodialysis presented with a precipitous hemoglobin drop to 6.8 g/dL. Investigation revealed replete hematinics but profound reticulocytopenia. After excluding occult gastrointestinal bleeding, hemolysis, and nutritional deficiencies, a bone marrow biopsy demonstrated isolated erythroid aplasia with preserved myeloid and megakaryocytic lineages, leading to a diagnosis of PRCA. Anti-EPO antibody testing was not performed, which limits definitive etiological confirmation. Due to the high risk of immunosuppression in an elderly patient and the limited accessibility of hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs), management was restricted to ESA cessation and supportive transfusions. This case highlights the diagnostic approach for severe anemia and the significance of profound reticulocytopenia in PRCA. The definitive hallmark remains the detection of circulating anti-EPO antibodies paired with a bone marrow study demonstrating near-total depletion of erythroid precursors, but preserved myeloid and megakaryocyte lineages. Management includes the permanent cessation of ESAs, immunosuppression to reduce circulating antibodies, and supportive blood transfusions. In chronic hemodialysis patients, early recognition of iatrogenic PRCA is essential to prevent the continued administration of potentially harmful ESAs and to facilitate a transition toward alternative therapies, such as HIF-PHIs.

Gastrointestinal angioectasia is considered one of the leading causes of lower gastrointestinal bleeding in elderly patients. It represents the most frequent vascular abnormality within the gastrointestinal tract, with lesions most commonly found on the right side of the colon. Endoscopic management includes several techniques aimed at removing abnormal mucosal lesions. However, recurrent bleeding after endoscopic therapy is common and may require repeated endoscopic interventions or additional therapeutic modalities. Patients typically present with intermittent, painless gastrointestinal bleeding. The lesions may be solitary or multiple, most frequently located in the stomach, small intestine, or right colon. Diagnosis is mainly established through endoscopy. Initial treatment usually involves endoscopic coagulation, while more severe cases may require angiographic embolization or surgical resection. We present the case of a 78-year-old man who presented with severe transfusion-requiring iron-deficiency anemia without ongoing overt gastrointestinal bleeding and was found to have an unusually large cecal angioectasia that differed from the small, flat lesions typically described in the literature. The lesion was successfully managed with mechanical clipping rather than conventional thermal ablation, highlighting an alternative endoscopic approach for selected large vascular lesions.

Gastrointestinal metastases from non-small cell lung cancer (NSCLC) are rare and usually focal. Diffuse small bowel involvement without discrete lesions is uncommon and often radiographically occult.An elderly man with a history of poorly differentiated NSCLC, previously treated with pembrolizumab, presented with recurrent ascites, profound anasarca, dizziness and anaemia. Multiple endoscopic evaluations, CT scans and a positron emission tomography-CT were unrevealing. Due to prior immunotherapy exposure and diffuse jejunal inflammation, immune checkpoint inhibitor enteritis was suspected, showing transient response to corticosteroids. However, push enteroscopy later revealed diffuse, friable proximal jejunal mucosa. Biopsy confirmed metastatic carcinoma (cytokeratin 7 positive, cytokeratin 20, caudal-type homeobox transcription factor 2 and thyroid transcription factor 1 negative), and molecular profiling showed 80% programmed death-ligand 1 expression. The patient's condition deteriorated and he died shortly after the diagnosis was made.This case emphasises that diffuse intestinal metastases can evade conventional imaging and superficial biopsies, mimicking immunotherapy-related enteritis. Persistent clinical suspicion, repeat endoscopy and deep histopathological confirmation are vital.

Background: The incidence of early-onset colorectal cancer (EOCRC) is rising, yet the relative contribution of metabolic, inflammatory, and laboratory abnormalities remains incompletely defined. Objectives: We compared these associations between EOCRC and late-onset colorectal cancer (LOCRC) while addressing the possibility that some laboratory abnormalities may reflect occult cancer rather than antecedent risk. Methods: We conducted a matched case-control study using the TriNetX US Network. Adults diagnosed with CRC between 2010 and 2023 were identified as EOCRC (18-49 years) or LOCRC (50-75 years). Patients with prior malignancy, inflammatory bowel disease, hereditary or familial CRC risk, or prior colectomy were excluded. Three separate analyses were performed. First, a direct EOCRC-versus-LOCRC comparison evaluated gastrointestinal symptoms during the 6 months preceding diagnosis. Second, EOCRC and LOCRC were each compared with their respective matched cancer-free controls to assess clinical, metabolic, and laboratory features during the 24 months preceding diagnosis. When multiple laboratory values were available, the most recent value preceding the index date was used. Conditional logistic regression estimated adjusted odds ratios with 95% confidence intervals, with Bonferroni correction applied for multiple comparisons. Results: The direct matched EOCRC-versus-LOCRC comparison included 7752 patients with CRC, comprising 2584 with EOCRC and 5168 with LOCRC. EOCRC more frequently presented with rectal bleeding, abdominal pain, diarrhea, iron-deficiency anemia, and weight loss. Rectal tumors were more common in EOCRC, whereas proximal tumors were more common in LOCRC. In separate control-based analyses, 3217 patients with EOCRC and 12,112 patients with LOCRC were compared with 6434 and 24,336 matched cancer-free controls, respectively. The strongest independent features associated with EOCRC were severe obesity (aOR 2.61), microcytosis (aOR 2.29), low ferritin (aOR 2.11), and elevated C-reactive protein (aOR 1.87). Similar but generally attenuated associations were observed in LOCRC. In adjusted EOCRC-versus-LOCRC analyses, obesity (aOR 1.38), metabolic syndrome (aOR 1.41), and MASH (aOR 1.22) remained more closely associated with EOCRC. Conclusions: EOCRC is associated with a distinct clinical-metabolic phenotype, with more pronounced metabolic, inflammatory, and hematologic abnormalities than LOCRC. These findings should be interpreted as hypothesis-generating prediagnostic associations, not as validated predictors or causal risk factors.

 Gastrointestinal bleed is the most common diagnosis among GI-related hospital admissions. Of all the GI hemorrhages, nearly 50% are due to upper GI bleeding. The most common causes of upper GI bleed include peptic ulcer disease, gastroesophageal varices, esophagitis, angioectasia, and vascular lesions. The etiology is unknown in about 8% of the cases.[1]  Cameron lesion is a rare cause of occult upper GI bleed. Cameron lesions are linear gastric ulcers or erosions on the mucosal folds at the diaphragmatic impression in patients with a large hiatal hernia. Cameron lesions were first described in 1986 by Cameron and Higgins. The lesions were seen in people who had the chest X-ray showing one-third or more of the stomach above the diaphragm. Of the total cases, 50% were found to be anemic.[2][3]

Background and Aim: Obscure gastrointestinal bleeding (OGIB) is defined as bleeding of unknown origin after comprehensive upper, lower, and small-bowel evaluations. However, the incidence and predictors of rebleeding after negative comprehensive gastrointestinal evaluation remain unclear. We aimed to identify predictors of rebleeding and develop a simple risk stratification score for OGIB. Methods: We retrospectively analyzed 226 patients diagnosed with OGIB between 2009 and 2024. The primary outcome was rebleeding during follow-up. Independent predictors were identified using multivariable Cox proportional hazards analysis. A risk score was constructed from regression coefficients and evaluated using receiver operating characteristic analysis and Kaplan-Meier curves. Results: Among 226 patients, 87 (38.5%) had overt OGIB and 139 (61.5%) had occult OGIB. Rebleeding occurred in 30 (13.2%) patients. Multivariable analysis identified liver cirrhosis (β = 0.59, p < 0.01), overt OGIB (β = 0.69, p < 0.01), and aspirin use (β = 0.51, p = 0.02) as independent predictors. Each factor was assigned one point, yielding a 0-3 point score. The score showed modest discriminative ability (area under the curve = 0.68). Rebleeding rates increased progressively with increasing scores (5.6%, 17.5%, 27.3%, and 100% for scores 0, 1, 2, and 3, respectively) and were significantly higher in the high-risk group (p < 0.01). Conclusion: Rebleeding remained clinically relevant despite comprehensive gastrointestinal evaluation. The proposed risk score provides a simple and practical tool for identifying patients at increased risk of rebleeding and may support risk-adapted follow-up after a negative comprehensive gastrointestinal evaluation. Trial Registration: N/A.

Gastric antral vascular ectasia (GAVE) is an under-recognised cause of chronic gastrointestinal blood loss and iron-deficiency anaemia, caused by dilated antral vessels that cause chronic gastrointestinal bleeding, gradually depleting iron stores and leading to reduced haemoglobin levels. Its presentation is often subtle and may occur without overt gastrointestinal bleeding. We report an 82-year-old patient admitted following an unwitnessed fall, associated with postural hypotension and normocytic anaemia (Hb 90 g/L). Oesophagogastroduodenoscopy (OGD) demonstrated linear GAVE in the gastric antrum without active bleeding. The patient also sustained a fragility pelvic fracture. Intravenous iron therapy was administered to correct severe iron deficiency, resulting in improved haemoglobin levels and resolution of underlying clinical symptoms. This case highlights an important and often under-recognised presentation of GAVE, in which anaemia manifests predominantly through falls or orthostatic features rather than gastrointestinal symptoms. Early recognition of this pattern is crucial, as targeted treatment may reduce the risk of recurrent falls, fractures, and subsequent functional decline in older adults.

Background. Numerous countries use the EXTEL HEMO-AUTO MC quantitative faecal immunochemical test (qFIT) to screen for faecal haemoglobin. We aimed to determine if bacterial 16S rRNA gene sequencing results from the leftover qFIT cassettes would be stable over time and comparable with larger volume faecal collection protocols.Methods. Four qFIT probe samples were taken from each of sixteen fresh healthy volunteer stool samples, and sequencing results were compared after 0, 4, 7 and 14 days to provide a baseline control and mimic postage and sample processing conditions in cancer screening programmes. qFIT results were then compared to those of standard laboratory processing of larger whole-stool samples. DNA was extracted from 100 NHS surplus qFIT samples from symptomatic patients reporting rectal bleeding and quantified to assess suitability for 16S rRNA gene sequencing.Results. Bacterial composition and diversity from healthy volunteer qFITs remained stable over 14 days with only minor differences compared to baseline (day 0) and larger stool control samples; at least 75% of the symptomatic qFITs yielded sufficient DNA for 16S rRNA gene sequencing.Conclusion. qFIT samples were almost identical to control samples and stable over 14 days, allowing them to be used for large-scale, low-cost population-based intestinal microbiota studies.Clinical Trial Registration. The study was registered on clinicaltrials.gov (NCT06100549).