The modified Glasgow Blatchford Score performed as well as the full Glasgow Blatchford Score while outperforming both Rockall Scores for prediction of clinical outcomes in American patients with upper gastrointestinal bleed. By eliminating the subjective components of the Glasgow Blatchford Score, the modified Glasgow Blatchford Score may be easier to use and therefore more easily implemented into routine clinical practice.

We have recently seen a patient with volvulus of an ileal J-pouch after ileal pouch-anal anastomosis (IPAA). To our knowledge, only 3 cases of small bowel volvulus after IPAA have been reported, and only 1 occurred within the pouch.A 25-year-old man with a 2-year history of ulcerative colitis (UC) refractory to medical therapy underwent proctocolectomy with ileal J-pouch to anal anastomosis and temporary diverting ileostomy. Two weeks postoperatively the patient was treated conservatively for small bowel obstruction. Over the ensuing several months he presented with several episodes of abdominal pain and vomiting attributed to adhesive partial small bowel obstruction. Four months later the patient had an uneventful closure of his ileostomy.One year following ileostomy takedown he was admitted with partial small bowel obstruction treated conservatively, but he presented again 4 months later with complete obstruction. Abdominal radiographs at presentation showed dilated intestine consistent with a distal bowel obstruction confirmed by computed tomography (Fig. 1). A flexible pouchoscopy revealed complete obstruction and ischemia at the distal aspect of the ileal pouch with endoscopic findings suggestive of a twist (Fig. 2). The imaging and endoscopic findings were concerning for volvulus of the pouch. An attempt to decompress the volvulus endoscopically was unsuccessful. The patient was then taken to the operating room for exploratory laparotomy, which confirmed a pouch volvulus

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Primary hyperparathyroidism secondary to true sporadic synchronous parathyroid cancer (PTCa) and adenoma (PTa) is rare. This is a case of an 80-year-old female admitted with symptomatic hypercalcaemia, raised serum calcium (Ca) of 3.39 mmol/L and raised parathyroid hormone (PTH) of 44.3 pmol/L. Ultrasonic evaluation of the neck revealed a mass posterior to the right thyroid lobe. Imaging of the left neck was unremarkable. Subsequent sesta-MIBI and single-photon emission computed tomography-computed tomography (SPECT-CT) scanning highlighted conspicuous activity over the right lower neck consistent with the neck ultrasound scan findings. Pre-operatively, PTa was suspected. Intra-operatively, malignancy was suspected due to infiltration of the parathyroid tumour into the thyroid. The right inferior parathyroid and right thyroid gland were resected. Histology confirmed PTCa. Despite surgical treatment, she was found to have persistently high Ca and PTH levels. Further investigation with a repeat sesta-MIBI and SPECT-CT suggested a left inferior parathyroid tumour. Excision of this mass revealed a PTa. Recovery was unremarkable and serum biochemistry returned to normal ranges.