A Rare Case of Malignant Insulinoma Associated With Gastrointestinal Bleed.

A gastrointestinal bleed (GIB) in the setting of metastatic insulinoma is a rare phenomenon. It appears that cases of metastatic insulinoma causing GIB are rare, often influenced by the tumor's location. Our case involves an 82-year-old male with dementia and a history of recurrent hypoglycemia, presenting with an episode of altered mental status. The patient exhibited hypoglycemia alongside a melena episode and anemia. Diagnostic criteria, including Whipple's triad, confirmed endogenous insulin production. Computed tomography (CT) showed a left paraaortic/retroperitoneal mass. Esophagogastroduodenoscopy (EGD) visualized an extrinsic mass at the gastric body, which caused an ulcerated surface that was treated with clipping and hemostasis. The patient's recurrent hypoglycemic episodes were treated with glucose, while his GIB was managed with hemostasis and clipping. However, the patient was not a surgical candidate, and further medical treatment was ceased by the family.

Acute Hemorrhagic Rectal Ulcer Syndrome: A Known Yet Often Overlooked Etiology of Gastrointestinal Bleeding in Chronically Ill Patients.

Acute Hemorrhagic Rectal Ulcer Syndrome (AHRUS) is a known and potentially overlooked cause of severe gastrointestinal bleeding in patients with critical illness. It presents as a sudden and brisk painless bleed. It is common among elderly patients who have chronic conditions such as coronary artery diseases associated with the use of anti-platelets, diabetes mellitus, hypoalbuminemia, liver diseases, sepsis, stroke, and chronic renal failure on hemodialysis. AHRUS could result in fatal gastrointestinal hemorrhage. Here, we report a case of acute hemorrhagic rectal ulcer with the above-mentioned risk factors and make the argument that AHRUS should be an important differential in a similar population presenting with a gastrointestinal bleed.

Gastric Volvulus, An Important Yet Commonly Overlooked Etiology of Upper Gastrointestinal Bleeding: A Case Study.

Gastric volvulus is a distinct and uncommon pathology that usually presents with vomiting secondary to gastric outlet obstruction and gastrointestinal bleeding with an association with hiatal hernia. We present a case of a 71-year-old female who presented to the emergency department (ED) with a three-day history of coffee ground emesis. Of note, the patient was recently in the hospital under medical observation two weeks prior, with similar complaints of hematemesis. Chest X-ray revealed a left basilar opacity representing bowel gas suggestive of a hiatal hernia. Intravenous proton pump inhibitors were initiated but due to persistent recurrence of symptoms and progressive discomfort, a computed tomography (CT) of the chest and abdomen was ordered. This revealed a partial gastric volvulus with signs suggestive of vascular compromise of the herniated part of the stomach. She subsequently underwent emergent laparotomy, repair of the hiatal hernia, and partial gastrectomy and gastropexy. Post-surgical biopsy findings showed focal mucosal necrosis and ulceration, focal foveolar hyperplasia, edematous changes, and overall congestion in the submucosal tissue. She was discharged five days later with no complications or recurrence of symptoms.