Introduction: Gastrointestinal bleeding represents a serious clinical challenge due to the complexity of diagnosis and the therapeutic options required for effective management. Small bowel bleeding, although relatively rare, poses a significant diagnostic dilemma due to the difficulty in identifying the source and the variability of causes, which differ depending on the patient's age. In the elderly population, vascular malformations are the most common causes, whereas in younger patients, the etiology can be broader, including inflammatory diseases, tumors, and congenital abnormalities. The aim of this study was to investigate the clinical characteristics and outcomes of patients with hemodynamic instability due to small bowel bleeding, with a particular focus on the application of predictive scores (GBS and CRS). Materials and Methods: This retrospective observational study, conducted from January 2023 to January 2024, included 24 hemodynamically unstable patients with diagnosed small bowel bleeding. All patients were assessed using the Glasgow Blatchford Score (GBS) and Clinical Rockall Score (CRS) to evaluate risk and predict clinical outcomes. Demographic data, clinical and diagnostic information were analyzed, with comparative analyses of preoperative, intraoperative, and histopathological findings. Results: The mean age of the patients was 69.8 years, and 79.2% presented with hematochezia. All patients had GBS > 15 and CRS > 6. Conservative treatment was effective in 62.5% of patients, while 37.5% required surgical intervention. The mortality rate was 12.5%. Statistically significant positive correlations were found between GBS and mortality (r = +0.76, p < 0.05) and between GBS and surgical intervention (r = +0.32, p < 0.05). The most common causes of bleeding were vascular lesions, although the source of bleeding was unidentified in 11 patients. Conclusion: Small bowel bleeding remains a major challenge for clinicians, requiring a multidisciplinary approach to diagnosis and treatment. The use of predictive scores such as GBS and CRS aids in assessing severity, guiding decision-making, and planning further treatment.

Introduction: Colorectal cancer (CRC) is among the most common malignancies, with a rising global incidence. Synchronous tumors refer to the presence of multiple tumors simultaneously in different segments of the colon or rectum, while metachronous tumors occur during follow-up after initial treatment. These tumors are often undetected during standard diagnostic procedures, making intraoperative exploration and postoperative monitoring crucial for timely diagnosis and successful treatment. Case Report: A 63-year-old patient was admitted for sideropenic anemia and weight loss. Colonoscopy revealed a tumor in the cecum, confirmed as adenocarcinoma. During surgery, two additional tumor lesions were discovered in the ascending and transverse colon. Following an extended right hemicolectomy and adjuvant chemotherapy according to the FOLFOX protocol, the patient remained disease-free until May 2023, when a metachronous tumor in the rectum was detected. The lesion was removed via transanal excision, and histopathological findings indicated intramucosal carcinoma. Continuous follow-up until November 2024 showed no disease progression. Conclusion: Intraoperative exploration enabled the identification of previously undetected synchronous tumors, influencing the extent of surgery and the postoperative treatment plan. Regular monitoring, including colonoscopy and radiological methods, is essential for the early detection of metachronous tumors and achieving optimal outcomes. This case highlights the importance of a multidisciplinary approach in managing patients with synchronous and metachronous CRC.