Leiomyosarcomas are extremely rare and comprise only 1.2% of small bowel malignancies. Advancements in immunohistochemical techniques have allowed for the differentiation between leiomyosarcomas and gastrointestinal stromal tumors (GISTs). Leiomyosarcomas remain difficult to detect via endoscopy and require a more intricate diagnostic approach. The staging and sizing of these tumors are important prognostic indicators. We report a case of a 67-year-old male who presented with bulging lower extremity veins, abdominal bloating, and weight loss. A CT of the abdomen and pelvis revealed a pelvic mass arising from the small bowel and a metastatic hepatic lesion, which was found to be compressing the inferior vena cava. A biopsy of the hepatic lesion confirmed the diagnosis of metastatic leiomyosarcoma.

Gastrointestinal bleeding secondary to ischemic colitis (IC) is relatively infrequent. Drug-related etiologies of nonocclusive IC are very rare. Sympathomimetics have been reported to cause IC, with most cases being associated with the illicit use of amphetamines and methamphetamines. There are also a few reported cases of prescription dextroamphetamine-linked IC. However, there are no reported cases of lisdexamfetamine-linked IC. We exhibit a 32-year-old woman presenting with hematochezia after the use of lisdexamfetamine. Colonoscopy findings in this patient were suggestive of IC. In the absence of risk factors, the cause was attributed to the usage of lisdexamfetamine. The patient was managed conservatively and advised to discontinue the medication.