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: The incidence of esophageal and esophagogastric junction adenocarcinomas has been increasing in developed countries, with primary risk factors including gastroesophageal reflux disease (GERD), smoking, and obesity. Chronic GERD can lead to Barrett’s esophagus (BE), a premalignant condition that elevates the risk for esophageal adenocarcinoma. Case Report: We present a case of a 63-year-old woman with nausea and epigastric pain. Her history was notable for Sjögren’s syndrome and a positive family history of prostate cancer, without smoking or alcohol use. Endoscopy revealed a distal hiatal hernia and long-segment Barrett’s esophagus (LSBE) with a 3 cm ulcerated lesion at the gastroesophageal junction, located within the hernia sac. Biopsies confirmed well-differentiated adenocarcinoma in LSBE. CT imaging showed a tumor extending through the hiatal hernia with distal esophageal wall thickening and lymph node metastases but no distant metastases. The patient underwent a subtotal esophagectomy with lymphadenectomy and esophagogastric anastomosis using the Ivor Lewis procedure. Pathology confirmed adenocarcinoma with lymph node metastasis and a close circumferential resection margin. Six cycles of postoperative chemotherapy with platinum and fluoropyrimidine were administered. The patient was recurrence-free at a three-year follow-up. Conclusion: This case underscores the association between hiatal hernia, Barrett's esophagus, and esophageal adenocarcinoma, particularly in the setting of disrupted antireflux mechanisms. The findings support the importance of early investigation and monitoring in patients with GERD and BE to mitigate cancer progression.

Introduction: Primary adenocarcinoma of the appendix is a rare and heterogeneous malignancy, most commonly presenting as mucinous adenocarcinoma. Due to its nonspecific clinical manifestations, the diagnosis is often established at an advanced stage, frequently with already present peritoneal dissemination. Standard treatment for advanced mucinous appendiceal carcinoma involves cytoreductive surgery with HIPEC followed by systemic chemotherapy, or initial systemic therapy for downstaging, followed by repeat CRS and HIPEC. In cases where radical surgery is not feasible, the average survival is less than one year. Case report: We report a case of a 72-year-old woman with no relevant family history, who presented with acute right lower abdominal pain and distension. Imaging revealed multiple cystic peritoneal implants, ascites, and small bowel obstruction. Palliative emergency surgery demonstrated an appendiceal mass invading the right ovary, with widespread peritoneal mucinous deposits. Histopathological analysis confirmed mucinous adenocarcinoma of the appendix with peritoneal carcinomatosis. Postoperatively, the patient received 12 cycles of bevacizumab plus FOLFOX chemotherapy, achieving marked radiologic and biochemical improvement. Maintenance therapy with bevacizumab plus 5-FU/LV led to sustained disease stabilization. After 32 cycles, the patient developed an entero-vaginal fistula, which was surgically managed due to poor quality of life. Intraoperatively, the decision was made for cytoreductive surgery and fistulectomy. Postoperative imaging showed no evidence of disease. The patient remains progression-free for nearly three years, and disease-free for one year. Conclusion: This case highlights the potential for long-term survival in initially inoperable patients with advanced mucinous appendiceal adenocarcinoma and peritoneal carcinomatosis when treated with combined cytoreductive surgery and bevacizumab plus chemotherapy. Multimodal and individualized treatment strategies may significantly improve outcomes in this rare malignancy.