Background and Clinical Significance: Ganglioneuromas are rare benign tumors of neural crest origin, with gastrointestinal involvement being uncommon and ampullary localization exceptionally rare. Pancreatic neuroendocrine tumors (NETs) are also uncommon neoplasms with variable biological behavior. The coexistence of these two entities is unusual, particularly in the absence of an identifiable hereditary syndrome. Case Presentation: A 38-year-old man presented with hematemesis and multiple episodes of melena over 18 h and was found to have significant anemia with borderline hemodynamic stability. Upper gastrointestinal endoscopy revealed an enlarged, actively bleeding papilla of Vater, and initial hemostasis was achieved with adrenaline injection and endoscopic clipping. However, recurrent massive bleeding developed within 36 h, accompanied by hemodynamic instability. Repeat endoscopy confirmed ongoing hemorrhage, and the patient subsequently underwent emergency pancreaticoduodenectomy. Histopathological examination demonstrated an ampullary ganglioneuroma and an incidental well-differentiated pancreatic neuroendocrine tumor (WHO Grade 2). Surgical margins were negative, and no lymph node metastases were identified. Further evaluation for hereditary endocrine syndromes was unremarkable. The patient remains asymptomatic, with no evidence of recurrence during a 10-year follow-up period. This case highlights the diagnostic and therapeutic challenges associated with rare periampullary tumors. Although ganglioneuromas are typically benign, their anatomical location may result in severe clinical manifestations such as life-threatening bleeding. The coexistence with a pancreatic NET raises questions regarding potential shared pathogenesis, although no genetic syndrome was identified. Limitations of endoscopic management in uncontrolled bleeding and the importance of definitive surgical intervention are emphasized. Conclusions: This case highlights an exceptionally rare coexistence of ampullary ganglioneuroma and pancreatic neuroendocrine tumor presenting with life-threatening gastrointestinal bleeding. Although ganglioneuromas are benign, their anatomical location may result in severe clinical manifestations. Early recognition and decisive surgical management are crucial when endoscopic control fails. Favorable long-term outcomes can be achieved following complete resection.

Background In Tanzania, hepatosplenic schistosomiasis (HSS) is a common cause of morbidity and mortality among adult patients. However, capacity to manage HSS is very low. Here we report learning experience, capacity building, and collaborative partnership in establishing a functional gastrointestinal (GI) endoscopy unit. Methods A need assessment for a GI endoscopy unit at Nansio District Hospital was conducted. The findings highlighted a clear need for establishing the endoscopy unit, given the burden of HSS, its associated mortality, and the lack of skilled human resources. Key priorities included capacity building for human resources, renovation of the building, provision of scholarships for residents in internal medicine, establishment of an HSS patient registry and clinic, and strengthening of ultrasound services. Results The GI endoscopy unit commenced operations in August 2023. To date, a total of 666 patients have been attended (442 [66.4%] male and 224 [33.6%] female). Abdominal distension (66%), hematemesis (41%), and melena (41%) were common symptoms. Ultrasound examination revealed periportal fibrosis (PPF) in 71.5% of patients and liver image patterns C-F in 80.4%, both correlating with the severity of PPF. Of the 666 patients, 560 underwent endoscopic examination and the most common diagnosis was grade IV esophageal varices (52.1%). Among these, 84% underwent variceal ligation. On follow-up, 90% of patients achieved variceal eradication. Conclusion The establishment of the GI endoscopy unit at the district hospital in rural Tanzania was possible through the support of different stakeholders.

We report a case of a term neonate who developed massive haematemesis at 15 hours of life without identifiable risk factors. Despite conservative management, the bleeding persisted, resulting in haemorrhagic shock and anaemia. Endoscopy was not feasible due to a large intragastric haematoma, so surgical haemostasis was performed, revealing diffuse gastric erosion and multiple bleeding ulcers and the neonate recovered well postoperatively. This report shows that life-threatening bleeding can occur even in term neonates without identifiable risk factors. In cases of ongoing massive bleeding in which conservative and endoscopic management are unsuccessful or not feasible, surgical haemostasis may need to be considered.

Pancreatic arcade aneurysms are uncommon vascular lesions but may be fatal when rupture occurs. We describe the case of a 68-year-old woman who presented with hematemesis and profound anemia and was diagnosed with multiple pancreaticoduodenal artery aneurysms associated with median arcuate ligament syndrome (MALS). Contrast-enhanced computed tomography (CT) revealed a severe stenosis of the celiac artery origin with post-stenotic dilatation and aneurysmal changes within the pancreatic arterial arcade. Active bleeding from a ruptured posterior superior pancreaticoduodenal artery (PSPDA) aneurysm was successfully controlled by emergency coil embolization. To address the underlying hemodynamic abnormality and reduce the risk of further aneurysm formation or rupture, elective laparoscopic median arcuate ligament release was subsequently performed. Intraoperative Doppler ultrasonography demonstrated the restoration of antegrade hepatic arterial flow following decompression. This case highlights the importance of combining endovascular and surgical approaches in the management of pancreatic arcade aneurysms associated with MALS, with careful long-term follow-up.

Foreign body ingestion in adults is a clinically significant condition that may lead to serious complications, particularly in cases involving intentional ingestion of high-risk objects. We report the case of a 34-year-old woman who presented with a two-day history of hematemesis after intentionally ingesting two metallic foreign bodies approximately two weeks before admission. Imaging studies, including abdominal radiography and computed tomography, revealed elongated metallic objects measuring up to 6.8 cm within the stomach, associated with focal gastric wall thickening. Given the size of the objects, the presence of gastrointestinal bleeding, and the unavailability of therapeutic endoscopy, surgical management was pursued. The patient underwent exploratory laparotomy with gastrotomy, allowing the successful extraction of the foreign bodies and primary closure reinforced with an omental patch. Her postoperative course was uneventful, with progressive recovery and no recurrence of symptoms at follow-up. This case underscores the importance of early recognition, appropriate imaging, and timely intervention in high-risk foreign body ingestion, as well as the role of surgical management when endoscopic treatment is not feasible.

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.

Phlegmonous gastritis is a rare, fulminant bacterial infection of the stomach characterized by diffuse suppurative inflammation of the gastric wall. We report case of 65-year-old woman patient with chronic myeloid leukemia blast-phase who developed phlegmonous gastritis during profound neutropenia after chemotherapy treatment, presenting with acute severe epigastric pain accompanied by hematemesis. Contrast-enhanced computed tomography of the abdomen revealed marked diffuse gastric wall edema without evidence of perforation. Upper endoscopy showed severe infectious gastritis with histopathology confirmed, gram staining demonstrated Gram-positive cocci and rod-shaped organisms within the tissue. This case highlights the need for high clinical suspicion and immediate action are crucial to achieve favorable outcomes.

A 56-year-old woman presented with hematemesis and melena. She was hemodynamically stable, with hemoglobin at 5.2 g/dL. Upper gastrointestinal endoscopy after transfusion showed twisting of the second duodenum (D2). Computed tomography and magnetic resonance imaging revealed intussusception caused by a duodenal mass without ischemia. Endoscopic ultrasound was inconclusive, and tumor markers were normal. Exploratory laparotomy found no peritoneal carcinomatosis. Duodenotomy exposed a 7 cm pedunculated submucosal tumor in D 2. Cannulation of the cystic duct identified the papilla, and an Escat drain was inserted. The mass was resected using Endo-GIA. Postoperative recovery was uneventful; the drain was removed on Day 3, and the patient was discharged on Day 4. Histopathology confirmed a completely resected benign Brunner's gland harmartoma. After four years, no recurrence was observed. Brunner's gland hamartomas are benign tumors. Surgery is indicated when endoscopic treatment is not feasible.

A 15-year-old female patient presented with recurrent episodes of hematemesis over six months, with no identifiable source on initial evaluations, including upper gastrointestinal (GI) endoscopy and abdominal angiography. Despite a thorough workup for bleeding diatheses, the etiology remained elusive until whole-genome sequencing revealed a homozygous mutation in the ADAMTS2 gene, confirming Ehlers-Danlos syndrome (EDS), dermatosparaxis type (dEDS). Although bleeding is more common in vascular EDS, recurrent GI bleeding in this patient likely resulted from vessel wall weakness and defective collagen processing associated with dEDS. Management included celiprolol, vitamin C, multivitamins, and multidisciplinary follow-up. This case underscores the importance of genetic testing in diagnosing atypical connective tissue disorders and highlights a multidisciplinary approach for managing complex cases with recurrent, unexplained bleeding.