Non-portal hypertension-related upper gastrointestinal bleeding (UGIB) remains one of the most common emergencies in gastroenterology, accounting for the majority of UGIB cases in Western countries.Its incidence is estimated at 50-150 cases per 100.000 population per year, with a mortality rate that remains between 5% and 10% despite advances in diagnostic and therapeutic strategies. Clinical presentation is often abrupt, typically as hematemesis or melena, requiring prompt and structured management including initial resuscitation, diagnostic and therapeutic endoscopy, and secondary prevention.In recent years, the therapeutic armamentarium available to the endoscopist has expanded with the introduction of innovative devices such as over-the-scope clips, hemostatic powders, and gels. Several randomized trials have refined the optimal timing of endoscopy and compared the efficacy of various techniques.

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.

Upper gastrointestinal bleeding (UGIB) is a frequent cause of emergency department admission and is most commonly attributed to peptic ulcer disease or portal hypertension-related varices. In critically ill patients, however, pulmonary bleeding may be misinterpreted as hematemesis when blood is swallowed or expelled during retching or airway compromise. In patients undergoing long-term hemodialysis, catheter-related central venous thrombosis can precipitate atypical bleeding presentations. We report the case of a 45-year-old man with chronic kidney disease on maintenance hemodialysis who presented with sudden-onset recurrent hematemesis and hemodynamic instability. Initial evaluation suggested severe UGIB, prompting endotracheal intubation, vasopressor support, and urgent upper endoscopy. Endoscopy demonstrated small esophageal varices and erosive gastropathy without evidence of active bleeding. Subsequent chest computed tomography revealed superior vena cava thrombosis with extensive mediastinal collateral circulation and imaging findings consistent with pulmonary hemorrhage. Bronchoscopy confirmed active bleeding originating from the right bronchial tree, establishing the diagnosis of pulmonary hemorrhage secondary to superior vena cava thrombosis. This case underscores an important diagnostic pitfall: severe pulmonary hemorrhage may mimic UGIB, particularly when initial endoscopic evaluation is non-diagnostic. In hemodialysis patients, superior vena cava thrombosis and collateral vessel formation should be considered as potential mechanisms of airway bleeding even in the absence of classic superior vena cava syndrome. Early thoracic imaging and bronchoscopy are essential when endoscopic findings do not account for persistent or severe hematemesis to prevent diagnostic delays and inappropriate gastrointestinal interventions.

High-fidelity manikin scenarios for contaminated airway management and upper gastrointestinal bleeding (UGIB) depend on blood or hematemesis simulants that reliably occlude optics and reproduce the visual gestalt of real blood under high-intensity video laryngoscopy and flexible endoscopy lighting. Commercially available simulated blood products are frequently optimized for reusability, stain resistance, and compatibility with procedural trainers, and can be cost-prohibitive for repeated high-volume "soiling" curricula. However, many simulated blood products do not report optical opacity or camera-obscuration performance for this specific use case. We performed a targeted technical review of blood and bleeding simulant strategies used in manikin-based training and adjacent materials science literature, and we describe a low-cost, reproducible hematemesis analog composed of three packets of a raspberry-flavored powdered beverage mix - Crystal Light Sugar-Free Raspberry Ice Drink Mix (made from maltodextrin, citrate salts, calcium phosphate, organic acids, and FD&C dyes) - dispersed with 20 g of unsweetened cocoa powder - Hershey's Cocoa - in 1 L of water using an immersion blender. In preliminary qualitative bench use, this particulate suspension formulation produced a dark red-brown appearance and visually reduced light transmission compared with the dye-only beverage mixture. Objective optical, rheologic, and comparative performance testing was not performed in this introductory report. Direct material cost was approximately $1.66/L using representative U.S. retail pricing, compared with $7-$29/L for selected commercial powders and premixes, although this comparison reflects direct consumable cost only and does not establish performance equivalence. Limitations include sedimentation and phase separation over time (necessitating re-homogenization) and potential staining of the manikin; a spot test on non-critical surfaces is recommended prior to implementation. Because the formulation contains organic particulates, it should not be introduced into patient-care endoscope working channels or equipment intended for later clinical use unless local reprocessing staff verify complete clearance for the specific device. This report is intended as a preliminary formulation and microcosting analysis; future work should quantify viscosity (including shear-thinning behavior), density, spectral absorbance/scattering, and material compatibility to support standardization across simulation programs.

Gastrointestinal stromal tumors (GISTs) most commonly present with gastrointestinal bleeding or as an abdominal mass, whereas spontaneous rupture with pneumoperitoneum is distinctly uncommon and portends an adverse prognosis. A 51-year-old man presented with acute hematemesis and melena of two days' duration. Contrast-enhanced computed tomography of the abdomen demonstrated a large, lobulated, heterogeneously enhancing ileal mass with central necrosis, intralesional gas, direct communication with adjacent small-bowel loops, and free intraperitoneal air consistent with tumor rupture and pneumoperitoneum. Multiple additional mesenteric and pelvic masses with smooth peritoneal thickening and mild ascites suggested peritoneal dissemination. Emergency laparotomy confirmed tumor rupture with feculent peritonitis and widespread peritoneal seeding. Histopathology established a high-grade, multifocal GIST (pT4(m)N0) with spindle-to-epithelioid morphology, increased mitotic activity, necrosis, strong CD117 and DOG1 positivity, and an elevated Ki-67 labeling index. This case highlights the characteristic radiologic features of ruptured GIST and demonstrates close radiologic-pathologic concordance in an aggressive presentation.

We report a case of peripheral T-cell lymphoma (PTCL) initially presenting as idiopathic recurrent gastrointestinal hemorrhage, which had previously been misdiagnosed as multiple gastrointestinal ulcers. The recurrent hemorrhage proved to be refractory to conservative management. Unfortunately, the patient developed hemorrhagic shock due to massive gastrointestinal bleeding and was transferred to the intensive care unit (ICU). Emergency endoscopy revealed multiple ulcers in the duodenum and ileum, raising a strong suspicion for inflammatory bowel disease (IBD). However, the patient showed no significant improvement in response to corticosteroid therapy. After multidisciplinary consultation, intervention therapy was performed, but no evidence of contrast extravasation was observed. The patient continued to experience recurrent hematochezia and hematemesis, accompanied by profound anemia, with hemoglobin level dropping as low as 45 g/L. Subsequently, the patient's level of consciousness deteriorated, and progressive hypotension developed. Given the critical condition, emergency exploratory laparotomy was performed, which finally revealed multiple longitudinal ulcers, cobblestone-appearance mucosa, and numerous active bleeding sites throughout the large lumen of the small intestine. Consequently, partial small intestinal resection with enterostomy was carried out. Histopathological examination of the resected specimen ultimately confirmed the rare diagnosis of PTCL. Postoperatively, the patient's gastrointestinal bleeding significantly improved, and the patient was subsequently discharged. The rare case of life-threatening gastrointestinal bleeding underscores the necessity of heightened clinical awareness of PTCL to minimize misdiagnosis and delayed diagnosis, thereby facilitating timely intervention.

Hemobilia is an uncommon cause of upper gastrointestinal bleeding and represents a diagnostic challenge, particularly in patients with advanced biliopancreatobiliary disease. We report the case of a patient with pancreatic adenocarcinoma who developed massive hemobilia secondary to a gastroduodenal artery pseudoaneurysm, leading to hemodynamic instability and biliary stent dysfunction. An 82-year-old woman with a history of pancreatic adenocarcinoma under palliative management with an uncovered self-expandable metal stent presented with hematemesis, melena and presyncope. Upper GI endoscopy was performed with active bleeding through the biliary stent. Later Endoscopic retrograde cholangiopancreatography (ERCP) revealed a large intrastent clot causing obstruction. With contrast-enhanced abdominal computed tomography angiography, a pseudonaeuysm of the gastroduodenal artery. The patient subsequently underwent transcatheter arterial, achieving successful hemostasis. She was discharged seven days later with no recurrence of bleeding.

Subepithelial tumors of the esophagus are rare findings, with lipomas representing a particularly uncommon entity. They account for only about 0.4-1 % of benign esophageal tumors, but despite their benign nature, they can become symptomatic due to their size and location. Modern endoscopic techniques such as endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or submucosal tunneling endoscopic resection (STER) allow for safe and minimally invasive removal in selected cases.

Primary aortoenteric fistula (AEF) is a rare but fatal cause of upper gastrointestinal bleed. A 27-year-old previously healthy man presented with massive hematemesis, melena, severe anemia and hemodynamic instability. Point-of-care ultrasound and chest radiography suggested thoracic aortic pathology, and CT aortography confirmed a descending thoracic aneurysm with contained rupture and fistulous communication with the esophagus. This case highlights the need to consider rare vascular causes in massive hematemesis, where early imaging can facilitate rapid diagnosis and timely intervention.

Delayed postoperative hemorrhage after total gastrectomy is rare and may occur in the absence of an identifiable intraluminal bleeding source. Vascular complications, including splenic artery pseudoaneurysm, represent an uncommon but potentially life-threatening etiology. We report the case of a 67-year-old woman who underwent open total gastrectomy with Roux-en-Y reconstruction and standard D2 lymphadenectomy for gastric adenocarcinoma. Fourteen days postoperatively, she presented with acute hematemesis and hemodynamic instability. Endoscopic and surgical exploration failed to identify a bleeding source. Computed tomography angiography revealed a splenic artery pseudoaneurysm, which was successfully managed with endovascular stent placement. Splenic artery pseudoaneurysm should be considered in patients presenting with delayed bleeding after gastrectomy when conventional investigations are inconclusive. Computed tomography angiography is essential for diagnosis, and endovascular therapy is a safe and effective first-line treatment.

Gastric metastases are rare, accounting for only 0.2%-0.7% of gastric malignancies. Gastric metastasis from primary popliteal fossa leiomyosarcoma (LMS) has not been previously reported. We report a 60-year-old female who presented with hematemesis and severe anemia, with a past medical history of right popliteal fossa LMS resection. Imaging and endoscopy revealed a bleeding nodular lesion in the gastric body. Pathology and immunohistochemistry (SMA+/Desmin+, CD117-/DOG-1-) confirmed metastatic LMS to the stomach, with suspected pancreatic and bone metastases. The patient underwent emergency embolization for active bleeding, followed by laparoscopic partial gastrectomy and systemic chemotherapy. At the 9-month follow-up, she remained in good general condition. This case highlights that in patients with a history of malignancy presenting with gastrointestinal bleeding, gastric metastasis should be considered, and multidisciplinary management combined with surgery and systemic therapy can achieve favorable outcomes.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and highly aggressive hematologic malignancy that commonly presents with skin involvement and may also involve the bone marrow, peripheral blood, and lymph nodes. The coexistence of BPDCN with a primary solid tumor is extremely uncommon and poses substantial diagnostic and therapeutic challenges. We report a 70-year-old man who was first diagnosed with BPDCN after excision of a left forearm lesion and later developed recurrent hematemesis during chemotherapy. Subsequent endoscopic evaluation revealed a bleeding cardia lesion, and repeat biopsy confirmed poorly differentiated gastric cardia adenocarcinoma. After multidisciplinary evaluation, radical gastrectomy was performed first to control tumor-related bleeding, after which systemic chemotherapy for BPDCN was resumed. This case suggests that, in BPDCN patients who develop hematemesis, progressive anemia, or weight loss during treatment, prompt evaluation for a second primary gastrointestinal malignancy is warranted, and control of active tumor-related bleeding may need to precede hematologic therapy.

This case report describes an 84-year-old female who developed a fatal aortoesophageal fistula (AEF) 19 years post-chemoradiotherapy (CRT) for advanced esophageal cancer (cT4N2M1b (HEP), and cStage IVB). The patient was treated with fluorouracil, cisplatin, and 50-Gy radiation and achieved complete remission with no recurrence. She remained under long-term follow-up. Two years before the fatal event, an esophageal ulcer was noted in the irradiated area during routine endoscopy;however, the biopsy showed no malignancy. The ulcer was managed with a proton pump inhibitor, and follow-up endoscopy confirmed healing. One year later, she collapsed at home due to massive hematemesis and was transported to the emergency department in hemorrhagic shock. Emergency endoscopy revealed findings highly suggestive of AEF. Despite attempts at balloon tamponade for hemostasis, she went into cardiac arrest and could not be resuscitated. An autopsy confirmed a 3-mm fistula between the esophagus and aorta at the post-radiotherapy site. Histopathology revealed chronic radiation-induced ulceration, vascular wall thickening, and severe capillary narrowing in the outer esophageal membrane. Giemsa staining revealed bacterial infiltration at the fistula site, suggesting that secondary suppurative aortitis was the cause of fistula formation. Notably, no residual or recurrent tumor was detected. AEF is a rare but catastrophic late complication of CRT for esophageal cancer and is often fatal.