Balloon tamponade placement for variceal hemorrhage is a critical but rarely performed emergency procedure. Current hands-on low-fidelity simulation task trainers are limited, leaving a gap in high-quality training. We developed an anatomically accurate, cost-effective task trainer constructed from commonly available Emergency Department items to teach balloon tamponade device insertion for controlling variceal bleeding. This descriptive report of a low-fidelity simulation model uses 5-inch pieces of flexible silicone tubing to simulate the esophagus, connected to a 1-liter bottle as the stomach, with a 14-gauge angiocatheter inserted into the tubing to mimic variceal bleeding. The model was designed for integration with upper airway models for realistic simulation. This reproducible, cost-effective platform ($2.25 per model) provides hands-on training in balloon tamponade placement, with transparent design allowing clear visualization of device placement and balloon inflation, while modular construction enables integration with the existing simulation equipment. This innovative task trainer addresses the limited exposure to balloon tamponade procedures in emergency medicine training, providing an accessible and practical solution for skill development in managing variceal bleeding.

Dieulafoy's ulcer is a rare but potentially fatal vascular malformation characterized by the presence of an abnormally large submucosal arteriole that erodes the overlying mucosa without an identifiable primary ulceration. Its duodenal location is exceptional. We report the case of a 76-year-old patient with multiple comorbidities, admitted to the emergency department of the Avicenne Military Hospital in Marrakech for melena that had been progressing for four days, accompanied by severe anemia (Hb 5.4 g/dL). An upper gastrointestinal endoscopy (EGD) revealed a Dieulafoy's lesion in the second part of the duodenum (D2), with spontaneous, diffuse bleeding and no visible ulceration. Endoscopic hemostasis was achieved by injection of adrenaline (6 cc) followed by the placement of two hemostatic metal clips, with a good clinical outcome.

A portal cavernoma is a network formed by localized dilation of the hepatic portal system. This study aims to describe a case of portal cavernoma in a 69-year-old adult presenting with gastrointestinal hemorrhage. This is a 69-year-old patient with no particular medical history admitted for hematemesis associated with diffuse abdominal pain. Clinical examination revealed blood pressure of 100/60 mmHg and tenderness in the epigastric region. Upper gastrointestinal endoscopy revealed a large bulbar ulcer in flare-up. Helicobacter pylori testing in stool samples was positive. The initial diagnosis was a bulbar ulcer, and the patient was placed on treatment to eradicate H. pylori. However, an abdominal ultrasound performed later suggested heterogeneous portal vein thrombosis, which was confirmed by abdominal CT scan. Given these findings, we made a diagnosis of portal cavernoma revealed by gastrointestinal hemorrhage. Treatment consisted of 40 mg of injectable omeprazole every 12 h, 40 mg of propranolol per day, and one sachet of Gaviscon every 8 h. Anticoagulation was initiated with enoxaparin and then continued with 4 mg of acenocoumarol per day. The patient responded well to treatment, with regression of abdominal pain and gastrointestinal hemorrhage, and was discharged home after 10 days following two stable INR readings. Although most commonly described in pediatrics, this clinical case sheds light on adult forms of the disease.

We present the case of a 45-year-old male with repeated episodes of upper gastrointestinal bleeding due to a gastric arteriovenous malformation (AVM). The case underscores the diagnostic challenges, multidisciplinary decision-making, and management considerations associated with gastrointestinal vascular malformations. Given the rarity of gastric AVMs and their potential for serious complications, this report highlights the importance of an integrated approach to diagnosis and treatment, including advanced imaging and endovascular interventions.

Introduction The number of older patients receiving maintenance hemodialysis is increasing in Japan. Patients aged 75 years or older often have multimorbidity, frailty, nutritional vulnerability, and a higher risk of adverse clinical outcomes than younger patients. However, real-world longitudinal data from regional hospitals regarding mortality and clinically important complications in this population remain limited. This study aimed to compare five-year mortality, baseline clinical characteristics, laboratory findings, GI bleeding, and fractures between maintenance hemodialysis patients aged 75 years or older and those younger than 75 years. Methods This retrospective, single-center, longitudinal observational study included all eligible patients receiving maintenance hemodialysis at Takagi Hospital, a regional core hospital in Fukuoka, Japan, on December 1, 2017. Patients were categorized by baseline age into an older group aged 75 years or older and a younger group younger than 75 years. Baseline demographic, clinical, and laboratory data were extracted from electronic medical records. Follow-up continued until death or December 2022. The primary outcome was five-year all-cause mortality. Secondary outcomes included cause-specific mortality, endoscopy-confirmed GI bleeding, imaging-confirmed fractures, and baseline laboratory parameters. Between-group comparisons were performed using Student's t-test for continuous variables and the chi-square test for categorical variables. Results A total of 151 patients were analyzed, including 57 patients aged 75 years or older and 94 patients younger than 75 years. Five-year all-cause mortality was significantly higher in the older group than in the younger group (34/57 (59.6%) vs. 21/94 (22.3%), P < 0.001). Deaths due to renal failure and infection were also more frequent in the older group (21.1% vs. 6.4%, P = 0.007; and 19.3% vs. 5.3%, P = 0.007, respectively), whereas cerebrovascular/cardiovascular mortality did not differ significantly between groups (7.0% vs. 8.5%, P = 0.742). Upper-body fractures occurred more frequently in the older group than in the younger group (21.1% vs. 6.4%, P = 0.007), while lower-body fractures and gastrointestinal bleeding showed no statistically significant differences. The older group had significantly lower serum albumin and phosphorus levels than the younger group. Conclusion Among maintenance hemodialysis patients treated at a single regional Japanese hospital, a baseline age of 75 years or older was associated with higher five-year all-cause mortality, more frequent upper-body fractures, and lower serum albumin and phosphorus levels. These findings suggest that older hemodialysis patients may require individualized, multidisciplinary care focused on nutritional status, infection prevention, fracture and fall risk, and supportive care. Because this was a retrospective single-center study, further multicenter prospective studies are needed to validate these findings and clarify targeted interventions for this vulnerable population.

Acute upper gastrointestinal bleeding (AUGIB) is a common reason for emergency room presentation and can cause significant morbidity and mortality. Most studies only describe outcomes among admitted individuals. The aim of the study was to evaluate incidence, outcomes, and prediction model usage for all AUGIB presentations at Landspitali University Hospital, Iceland regardless of hospital admission.

Intracapsular hemorrhage occurs occasionally in acute pancreatitis complicated with pseudocyst that can be managed using laparoscopic gastric cyst anastomosis and drainage. However, cyst recurrence many years later and secondary splenic artery pseudoaneurysm rupture and hemorrhage leading to bloody vomiting and syncope are uncommonly reported. A woman in her late 40s was admitted for bloody vomiting, melena, anemia, and syncope. She underwent laparoscopic gastric cyst anastomosis and drainage for severe acute pancreatitis 3 years ago. Gastroscopy identified a bleeding gastric vascular malformation. Metal clips were used for endoscopic hemostasis. Abdominal enhanced computed tomography revealed a cystic lesion in the tail of the pancreas (4.2 × 3.9 cm) connected with the stomach wall and a splenic artery pseudoaneurysm in the cyst. Splenic artery pseudoaneurysm embolization was performed. The patient remains asymptomatic 2 years after embolization. Percutaneous selective embolization of a splenic artery pseudoaneurysm may be the preferred choice for patients with a pancreatic pseudocyst complicated by rupture and hemorrhage of the splenic artery pseudoaneurysm in the pancreatic pseudocyst. Clinicians should be alert regarding the possibility of recurrence after prior drainage, highlighting the importance of long-term follow-up.

Duodenal Kaposi sarcoma (KS) without cutaneous involvement is rare and may be diagnostically overlooked because gastrointestinal (GI) involvement can be clinically silent until complications occur. We present a 38-year-old man with a 6-year history of untreated HIV, found to have duodenal KS on endoscopic biopsy before any skin lesions. This case highlights that visceral KS should be considered in the differential diagnosis of upper GI bleeding in advanced HIV even in the absence of cutaneous findings, given the prognostic implications and higher mortality associated with GI involvement.

Bile duct injuries following blunt abdominal trauma are rare complications that may go unnoticed during emergency care. Due to edema and inflammation, these injuries can lead to bile duct obstruction, resulting in dilation of the hepatobiliary system and potential perforations. Such cases are medical emergencies that require prompt and effective management. This case report aims to present a rare case of bile duct stenosis secondary to blunt abdominal trauma, managed using a minimally invasive approach. Outcomes following endoscopic retrograde cholangiopancreatography (ERCP) are also described. A 25-year-old male patient was admitted with progressive right upper quadrant abdominal pain, accompanied by nausea, vomiting, jaundice, choluria, and acholic stools, occurring two months after sustaining blunt abdominal trauma in a car accident. The trauma had resulted in liver and pancreatic injuries, which were managed conservatively. Imaging revealed bile duct dilation and an abrupt transition in the caliber of its distal third, suggestive of biliary injury. Due to obstructive jaundice, the patient underwent ERCP, which confirmed significant bile duct stenosis. A biliary sphincterotomy was performed, and a prophylactic pancreatic stent was placed to reduce the risk of post-ERCP pancreatitis. However, the patient subsequently developed acute pancreatitis and hemorrhagic shock. Upper gastrointestinal endoscopy identified bleeding and sclerosis of the duodenal papilla. Endoscopic hemostasis using clips, bile duct drainage, and placement of a biliary prosthesis were performed, resulting in clinical improvement. Seventeen days later, the patient developed hospital-acquired pneumonia with pleural effusion and underwent thoracostomy with closed pleural drainage, along with antibiotic therapy using piperacillin and tazobactam, which resolved the condition. The patient remains under outpatient follow-up, undergoing serial dilation of the bile duct. Bile duct strictures are rare complications of blunt abdominal trauma and can have serious consequences. Therefore, it is essential for healthcare teams to remain vigilant for potential biliary tract involvement in post-traumatic patients, maintaining a high index of suspicion in the presence of clinical deterioration or symptoms of biliary obstruction.

Acute esophageal necrosis (AEN), also known as "black esophagus," is an uncommon clinical entity characterized by diffuse, circumferential, dark pigmentation of the esophageal mucosa. Its pathogenesis is explained by a "two-hit" mechanism involving systemic hypoperfusion and local chemical injury from gastric acid. We present the case of a 78-year-old man with a history of hypertension, diabetes, and a recent anteroseptal myocardial infarction complicated by cardiogenic shock, requiring triple stent placement and vasopressor support. One week after discharge, the patient was readmitted due to hematemesis and hemodynamic instability. Upper gastrointestinal endoscopy revealed extensive necrotic tissue in the distal third of the esophagus, ending abruptly at the gastroesophageal junction. A thoracoabdominal computed tomography scan confirmed esophageal wall thickening but ruled out perforation. Management was strictly conservative, consisting of total parenteral nutrition for esophageal rest, aggressive acid suppression with intravenous proton pump inhibitors, and optimization of cardiac output. A follow-up endoscopy performed seven days later showed complete resolution of the necrotic lesions. Although AEN carries a high overall mortality rate, death is usually attributed to underlying comorbidities rather than esophageal complications. This case highlights that prompt stabilization of the triggering hemodynamic event, combined with conservative medical therapy, allows for rapid mucosal recovery and prevents the need for invasive surgical intervention.