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.

Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms and the most common sarcomas of the gastrointestinal tract. Small bowel GISTs, particularly jejunal tumors, frequently present with occult or overt bleeding leading to anemia, but are uncommon causes of melena when routine endoscopy has not been performed. We report a 67-year-old man who presented with one week of intermittent melena and profound anemia (hemoglobin 5.3 g/dL). Computed tomography (CT) angiography revealed a 5 cm jejunal mass without active bleeding. The patient underwent exploratory laparotomy with segmental resection and side-to-side anastomosis. Pathology confirmed a low-grade spindle cell GIST confined to the submucosa and muscularis propria, with strong diffuse CD117 and DOG1 positivity, scattered CD34 staining, and a Ki-67 index of ~3%. The patient recovered uneventfully with resolution of bleeding and normalization of hemoglobin. This case highlights the importance of considering small bowel GIST in unexplained melena and severe anemia and demonstrates the curative potential of timely surgical resection in localized low-risk disease.

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.

This is a case of a woman in her 70s who demonstrated an uncommon presentation and consequence of diffuse large B-cell lymphoma (DLBCL). She presented with a month of generalized weakness and 1-2 weeks of melena. She was found to be anemic and had 1,25-dihydroxyvitamin D (calcitriol)-mediated hypercalcemia. Computed tomography (CT) of the abdomen and pelvis revealed a liver mass. Esophagogastroduodenoscopy (EGD) showed a gastric ulcer, biopsied without evidence of active bleeding. Liver mass was biopsied. Positron emission tomography scan demonstrated an F-18 fluorodeoxyglucose (FDG)-avid hepatic mass with an FDG-avid lymphadenopathy above and below the diaphragm. Gastric biopsy was consistent with a lymphoma, and liver biopsy returned positive for DLBCL. She received two units of packed red blood cells. With comorbidities of heart failure and chronic kidney disease, she was judiciously given isotonic saline, calcitonin, prednisone, and denosumab for hypercalcemia.

A 62-year-old male presented with a 9-month history of intermittent epigastric distension and pain, accompanied by acid reflux, nausea, vomiting, melena, and weight loss. Physical examination revealed epigastric tenderness. Laboratory tests showed hemoglobin of 94.0 g/L and serum albumin of 22.55 g/L. Gastroscopy identified gastric cancer in the antrum with gastric retention. Pathological biopsy of the antrum confirmed poorly differentiated adenocarcinoma. Colonoscopy revealed multiple small colonic polyps (maximum diameter 5 mm). Contrast-enhanced computed tomography (CT) of the upper abdomen demonstrated an approximately 6 cm lesion in the gastric antrum and a mesenchymal malignant tumor measuring approximately 10 cm in diameter in the left hepatorenal space, along with ascites in the abdominal and pelvic cavities. The patient received preoperative nutritional support, which improved his anemia, hypoalbuminemia, and overall physical condition. Under general anesthesia, he underwent distal gastrectomy with D2 lymph node dissection and Billroth II reconstruction, combined with resection of the retroperitoneal tumor. Postoperative pathology confirmed the gastric lesion as an ulcerative poorly differentiated adenocarcinoma and the retroperitoneal tumor as a pleomorphic liposarcoma (PLPS). The patient recovered well and was discharged. For the gastric cancer, he received 6 cycles of adjuvant chemotherapy with the SOX regimen (Oxaliplatin plus S-1). Follow-up examinations, including gastroscopy and contrast-enhanced CT of the upper abdomen, were performed at 3, 6, 12, 18, 24, 30, 36, 42, and 48 months postoperatively. No evidence of tumor recurrence was detected during this follow-up period. This paper reports a concurrent case of gastric cancer and PLPS, detailing the case characteristics, diagnostic and therapeutic procedures, and postoperative follow-up. The purpose of this study is to analyze the features of this Multiple primary malignant neoplasms (MPMN) case and provide a reference for selecting appropriate clinical treatments to improve patient prognosis.

We present the case of a young man with no notable medical history and who was not on anticoagulant or antiplatelet therapy but presented with chest pain shortly and melena after eating nuts. He had a large 20-cm dissecting intramural hematoma in the esophagus. Despite providing proton pump inhibitors as conservative treatment for 2 days, his chest discomfort persisted and hemoglobin level declined substantially; thus, endoscopic hematoma fenestration was performed. Repeat esophagogastroduodenoscopy 1 week postoperatively revealed substantial improvement in esophageal hematoma, with notable mucosal regeneration.

Hepatic artery pseudoaneurysm is a rare but potentially life-threatening vascular condition, with risks of rupture, fistula formation, and massive hemorrhage. It most commonly occurs secondary to trauma, infection, inflammation, or iatrogenic injury. In this report, the case of a 15-year-old boy with idiopathic juvenile arthritis who presented with chronic anemia, intermittent right upper quadrant and epigastric pain, low-grade fever, and occasional vomiting for two years is reported, with repetitive attacks of pancreatitis. Ultrasound of the abdomen showed sludge in the gallbladder. Magnetic resonance cholangiopancreatography (MRCP) showed the lumen of the gallbladder with an ill-defined fluid level suggestive of a sludge ball, and a wall thickness of 3 mm. So, a laparoscopic cholecystectomy was performed on the basis of the patient's symptoms and findings. Postoperatively, after one month, the patient had symptoms of abdominal pain, melena, and a fall in hemoglobin. CT scan and selective angiography revealed a small pseudoaneurysm arising from the medial branch of the left hepatic artery with associated biliary duct dilatation, suggestive of an arteriobiliary fistula. The patient underwent transcatheter coil embolization. Post-embolization angiography confirmed complete occlusion of the pseudoaneurysm with preserved hepatic arterial flow. Early recognition and timely endovascular intervention are essential to prevent life-threatening complications, including rupture and massive hemorrhage.

Jejunal diverticulosis is a rare cause of obscure gastrointestinal bleeding (OGIB) that can present with life-threatening hemorrhage. We report a 69-year-old male with recurrent melena, severe anemia, and hemodynamic instability requiring multiple transfusions. Upper and lower endoscopy were nondiagnostic, and CT angiography failed to localize the bleeding source. Capsule endoscopy showed distal small bowel bleeding without clear localization. The patient developed transfusion-dependent bleeding complicated by Klebsiella pneumoniae sepsis. Due to persistent hemorrhage, diagnostic laparoscopy was performed and revealed two jejunal diverticula with engorged mesenteric vessels. Segmental small bowel resection was done with complete resolution of bleeding. This case highlights the limitations of noninvasive modalities in intermittent small bowel bleeding and supports early surgical intervention when the bleeding source cannot be identified.

Taenia infection is a globally distributed parasitic disease that is uncommon in developed countries. Taeniasis typically presents with mild or no symptoms, and anemia is not a usual feature. We report the case of a 50-year-old woman with a history of Roux-en-Y gastric bypass who presented with a history of abdominal pain, asthenia, and melena. Blood tests revealed severe anemia, prompting endoscopic evaluation. EGD showed only postsurgical changes, and lower endoscopy revealed no bleeding source. Video capsule endoscopy demonstrated blood near the Roux-en-Y anastomosis and in the ileum. Enteroscopy subsequently identified a duodenal ulcer with recent bleeding and a tapeworm in the afferent limb. Hemostasis was achieved with hemostatic powder, and the patient was treated with praziquantel. At follow-up, she was asymptomatic, and her hemoglobin levels had normalized. Taeniasis is a rare cause of gastrointestinal bleeding, with only a few cases described in the literature. In this patient, the parasite was detected in the excluded limb of the gastric bypass. Mucosal injury caused by parasite attachment or movement may explain the bleeding. This case highlights the importance of considering parasitic infections in the differential diagnosis of melena, even in patients from non-endemic regions and without typical risk factors. Increased awareness of this rare presentation is essential to ensure timely diagnosis and treatment.