BACKGROUND: Due to rarity of duodenal GISTs, clinicians have few information about its clinical features, diagnosis, management and prognosis.
METHODS: We report a case of promptly diagnosed duodenal GIST in a 61-year-old Egyptian man presented shocked with severe attack of hematemesis and melena. Upper gastroduodenal endoscopy was done and revealed a large ulcerating bleeding mass at first part of duodenum 4 hemo-clips were applied with good hemostasis. An exploratory laparotomy and distal gastrectomy, duodenectomy and gastrojejunostomy were performed. The morphology of the mass combined with immunohistochemistry was consistent with duodenal gastrointestinal stromal tumours (GISTs) of high risk type. The patient is on amatinib one tablet daily and he was well with no evidence of tumor recurrence.
CONCLUSIONS: despite being rare, emergency presentation with sudden severe, life-threatening hemorrhagic shock duodenal GISTs might be a cause of potentially lethal massive combined upper and lower gastrointestinal bleeding which is the key feature of this rare and challenging tumor.

UNASSIGNED: Gastric teratoma is an extremely rare tumor, representing <1% of all pediatric teratomas, and commonly manifests as a palpable abdominal mass. Upper gastrointestinal tract bleeding in newborns and infants is rare and is mostly caused by a benign lesion.
UNASSIGNED: We present a 3-month-old boy who presented with recurrent attacks of hematemesis, vomiting, and melena which on work up revealed a gastric teratoma.
UNASSIGNED: Owing to the unique characteristics and the extreme rarity of this entity, accurate preoperative diagnosis has remained elusive.

BACKGROUND: Long tubular duplication is a rare congenital intestinal disease, that can lead to emergency situations marked by massive hemorrhage. However, preoperative diagnosis and surgical treatment are challenging. This report presents preoperative images and details a surgical procedure for long tubular intestinal duplications with massive hemorrhage.
METHODS: A 3-year-old boy presented to the emergency department with melena. Despite undergoing a Tc-99m pertechnetate scintigraphy one year prior, which revealed nonspecific findings with enhancement of some parts of the intestine, enhanced abdominal CT revealed an edematous small intestine with luminal extravasation. The patient received a transfusion of red blood cells; however, his hemoglobin level did not improve. Arterial angiography and double-balloon endoscopy revealed no remarkable findings. Exploratory laparotomy revealed a long tubular duplication in half of the small intestine. Utilizing the Wrenn procedure, we successfully removed all duplicate mucosa. Pathological findings showed that almost all duplications contained gastric mucosa and revealed an ulcer with a ruptured arterial vessel. His symptoms were resolved, and the hemoglobin level stabilized. At 2 months postoperatively, no surgical complications were present.
CONCLUSIONS: Effective management of long tubular duplications with massive hemorrhage involves timely application of the Wrenn procedure. Recognition of specific imaging findings is crucial to prompt exploratory laparotomy, ensuring optimal outcomes and preventing delays in treatment.

Gastrosplenic fistula (GSF) is an unusual event that might occur in patients with various gastric or splenic diseases. While GSF related to gastric and splenic malignancies is well-documented in the literature, cases of GSF due to a splenic abscess are extremely rare. We experienced the case of a 49-year-old man with a medical history of tricuspid cardiac valve replacement for infective endocarditis who presented with a sudden onset of anemia and melena. With the assistance of imaging and endoscopy, a primary splenic abscess complicated by spontaneous GSF was diagnosed. A prompt splenectomy with partial gastrectomy was performed. GSF is a serious occurrence associated with a high risk of morbidity and mortality. The early recognition of GSF related to a splenic abscess is crucial to prevent major complications. Surgical resection with splenectomy and partial gastrectomy is frequently preferred for the treatment of large abscesses with GSF.

BACKGROUND: Gastrointestinal (GI) metastases in lung cancer rarely occur.
METHODS: We report here the case of a 43-year-old male active smoker who was admitted to our hospital for cough, abdominal pain and melena. Initial investigations revealed poorly differentiated adenocarcinoma of the superior-right lobe of the lung: positive for thyroid transcription factor-1 and negative for protein p40 and for antigen CD56, with peritoneal, adrenal and cerebral metastasis, as well as anemia requiring major transfusion support. Over 50% of cells were positive for PDL-1, and ALK gene rearrangement was detected. GI endoscopy showed a large ulcerated nodular lesion of the genu superius with active intermittent bleeding, as well as an undifferentiated carcinoma with positivity for CK AE1/AE3 and TTF-1, and negativity for CD117, corresponding to metastatic invasion originating from lung carcinoma. Palliative immunotherapy with pembrolizumab was proposed, followed by targeted therapy with brigatinib. Gastrointestinal bleeding was controlled with a single 8Gy dose of haemostatic radiotherapy.
CONCLUSIONS: GI metastases are rare in lung cancer and present nonspecific symptoms and signs but no characteristic endoscopic features. GI bleeding is a common revelatory complication. Pathological and immunohistological findings are critical to diagnosis. Local treatment is usually guided by the occurrence of complications. In addition to surgery and systemic therapies, palliative radiotherapy may contribute to bleeding control. However, it must be used cautiously, given a present-day lack of evidence and the pronounced radiosensitivity of certain gastrointestinal tract segments.

Duodenal lipomas (DLs) are rare benign nonepithelial tumors that account for 4% of all gastrointestinal (GI) lipomas. DLs can occur in any part of the duodenum but most commonly arise in the second part of the duodenum. They are usually asymptomatic and discovered incidentally but may present with GI hemorrhage, bowel obstruction, or abdominal pain and discomfort. The diagnostic modalities can be based on radiological studies and endoscopy with the aid of endoscopic ultrasound (EUS). DLs can be managed either endoscopically or surgically. We report a case of symptomatic DL presenting with upper GI hemorrhage along with a review of the literature.  We report a case of a 49-year-old female patient who presented with a one-week history of abdominal pain and melena. Upper endoscopy revealed a single, large pedunculated polyp with an ulcerated tip in the first part of the duodenum. EUS confirmed features suggestive of a lipoma, including an intense homogeneous hyperechoic mass originating from the submucosa. The patient underwent endoscopic resection, with excellent recovery. The rare occurrence of DLs requires a high index of suspicion and radiological endoscopic assessment to rule out invasion into the deeper layers. Endoscopic management is associated with good outcomes and a decreased risk of surgical complications.

Leeches are a class of hermaphroditic parasites that can attach to various body parts and start sucking blood. Gastrointestinal (GI) bleeding due to leeches is a rare phenomenon that is more common in less developed countries. Common symptoms include melena, hematemesis, pallor, weakness, and fatigue. Due to the similar symptoms of this issue to the main differential diagnoses of GI bleeding in pediatrics, such as diarrhea, constipation, diverticulitis, esophagitis, and anal fissures, it is challenging to differentiate it from the rest.
We present a three-year-old boy who was transferred to our center with hematemesis, tarry stool, and a drop in hemoglobin level. He finally was diagnosed with a leech in his stomach.
In less developed counties, the inability to reach safe drinking water, swim in lakes or springs, and inadequate awareness of public health information among individuals can be risk factors for leech infestation.

Polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes (POEMS) syndrome is a rare plasma cell dyscrasia disease involving multiple organs combined with idiopathic non-cirrhotic portal hypertension. It has been reported only four times in the English literature. Here, we present the first case of a 62-year-old male POEMS syndrome patient with portal hypertension treated with the transjugular intrahepatic portosystemic shunt (TIPS), after he presented with a 10-day history of melena. The diagnosis of POEMS syndrome was given because the patient presented with polyneuropathy, monoclonal plasma cell proliferative disorder, sclerotic bone lesions, splenomegaly, lymphadenopathy, ascites, hypothyroidism, and hyperpigmentation. The presence of portal hypertension was confirmed by esophageal varices, congested and edematous stomach body, splenomegaly, and transudate ascites in which the serum-ascites albumin gradient of ascites fluid was over 11 g/L (a concentration considered to be associated with POEMS syndrome), as no other causes were found. The patient fasted and received conservative drug treatments on admission, but symptoms of melena soon recurred within 1 week after resuming his diet. After TIPS and venous embolization were performed, symptoms of bleeding were effectively controlled, while the patient subsequently developed hepatic encephalopathy, which ultimately led to death. The presence of gastrointestinal bleeding in POEMS syndrome with idiopathic non-cirrhotic portal hypertension indicates a poor prognosis. Given that this was the first patient to receive TIPS, and although the incidence of hepatic encephalopathy has increased, TIPS is still acceptable for refractory variceal bleeding.

Duodenal lipomas are uncommon and rare causes of gastrointestinal bleeding. Here, we present the case of a 45-yearold male patient who was admitted to University Clinical Centre because of melaena. After initial diagnostics, including echosonography, esophagogastroduodenoscopy revealed bleeding from protruding blood vessel at the polypoid submucosal change in the posterior duodenal bulb. Upon two urgent unsuccessful endoscopic hemostasis, a duodenotomy was performed. Definitive diagnosis was based on histological findings, describing duodenal lipoma with Bruner\'s gland hyperplasia. Upper GI bleeding is a serious challenge that requires adequate diagnostics necessary for the right choice of therapeutic approach. Unsuccessful endoscopic hemostasis could be followed by serious complications in bleeding duodenal lipoma when surgery should be always considered as the treatment of choice in patients with this kind of bleeding tumor. KEY WORDS: Bruner Glands Hyperplasia, Duodenal Lipoma, Upper Gastrointestinal Bleeding.
I lipomi duodenali rappresentano cause rare di sanguinamento gastrointestinale. Presentiamo qui il caso di un paziente maschio di 45 anni che è stato ricoverato al Centro Clinico Universitario per melena. Dopo la diagnostica iniziale, comprendente l’ecosonografia, l’esofagogastroduodenoscopia ha rivelato sanguinamen-to da un vaso sanguigno sporgente in corrispondenza della sottomucosa polipoide nel bulbo duodenale posteriore. Dopo due tentativi di emostasi per via endoscopica, eseguiti d’urgenza ma senza successo, è stata eseguita una duodenotomia. La diagnosi definitiva si basa sui reperti istologici, che descrivevano il lipoma duodenale con iperplasia della ghiandola di Bruner. Il sanguinamento del tratto gastrointestinale superiore è una sfida seria che richiede un’adeguata diagnostica necessaria per la giusta scelta dell’approccio terapeutico. L’emostasi endoscopica non riuscita potrebbe essere seguita da gravi complicazioni nel caso di lipoma duodenale sanguinante, laddove la chirurgia dovrebbe essere sempre considerata come il trattamento di scelta nei pazienti con questo tipo di tumore sanguinante.

BACKGROUND: Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is a rare primary intestinal T-cell lymphoma, previously known as enteropathy-associated T-cell lymphoma type II. MEITL is an aggressive T-cell lymphoma with a poor prognosis and high mortality rate. The known major complications of MEITL are intestinal perforation and obstruction. Here, we present a case of MEITL that was diagnosed following upper gastrointestinal bleeding from an ulcerative duodenal lesion, with recurrence-free survival for 5 years.
METHODS: A 68-year-old female was admitted to our hospital with melena and mild anemia. An urgent esophagogastroduodenoscopy (EGD) revealed bleeding from an ulcerative lesion in the transverse part of the duodenum, for which hemostatic treatment was performed. MEITL was diagnosed following repeated biopsies of the lesion, and cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy was administered. She achieved complete remission after eight full cycles of CHOP therapy. At the last follow-up examination, EGD revealed a scarred ulcer and 18Fluorodeoxyglucose (18FDG) positron emission tomography/computed tomography showed no abnormal FDG accumulation. The patient has been in complete remission for 68 mo after initial diagnosis.
CONCLUSIONS: To rule out MEITL, it is important to carefully perform histological examination when bleeding from a duodenal ulcer is observed.