Urachal adenocarcinoma is a rare but highly malignant epithelial cancer that accounts for <1% of all bladder malignancies and commonly presents with hematuria. We report a case of metastatic urachal adenocarcinoma presenting as bowel obstruction. A 54-year-old male patient with a history of alcohol abuse presented to the emergency with acute-onset, diffuse, cramping abdominal pain, worst in the epigastrium and lasting one day. Abdominal examination revealed moderate guarding and generalized tenderness with hypoactive bowel sounds. Imaging confirmed an evolving small bowel obstruction and a urachal remnant with a superimposed mass lesion. The patient underwent an exploratory laparotomy and a high-grade small bowel obstruction due to the mass was identified. An intraoperative frozen section identified adenocarcinoma. A biopsy of the urachal mass confirmed urachal adenocarcinoma. The final diagnosis was moderately differentiated urachal adenocarcinoma. The tumor was deemed unresectable due to the involvement of multiple loops of the small bowel and the mesentery of the small and large bowels. Systemic chemotherapy with 5-fluorouracil (5-FU), leucovorin, and oxaliplatin (modified FOLFOX-6) was initiated. Our patient did not report any prior urinary symptoms or recurrent abdominal pain, which are the common symptoms that urachal adenocarcinoma presents with. Bowel obstruction is a rare presentation of urachal adenocarcinoma since the spread of the disease to the viscera occurs much later in the course. This case report highlights a rare presentation of an even rarer malignancy.

A Dieulafoy lesion is an important consideration every gastroenterologist and internal medicine physician has to make in cases of recurrent, unidentifiable, and hemodynamically compromising gastrointestinal (GI) bleeding. A Dieulafoy lesion is an aberrant vessel that does not reduce in caliber when it extends from the submucosa to the mucosa. Damage to this artery can result in severe, intermittent arterial bleeding from tiny, difficult-to-visualize vessel stumps. Furthermore, these catastrophic bleeding episodes frequently result in hemodynamic instability and the need for transfusion of multiple blood products. As the patients presenting with Dieulafoy lesions often have concomitant cardiac and renal disease, familiarity with this condition is relevant as these patients are at risk of transfusion-related injuries. This case is unique as the Dieulafoy lesion was not visualizable in a standard location despite multiple esophagogastroduodenoscopy (EGD) and CT angiography, illustrating the difficulty of accurately managing and diagnosing this condition.

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Introduction: Gastroesophageal reflux disease (GERD) is a very common disease that often presents with symptoms such as heartburn, dysphagia, odynophagia, chronic cough, asthma, belching and regurgitation. Common etiologies of GERD are-Transient lower esophageal sphincter(LES) relaxation, motility disorder, lower esophageal sphincter (LES) incompetence, short lower esophageal sphincter (, 2 to 5 cm) and increased intra-abdominal pressure due to obesity or pregnancy for example. Dolichocolon is an uncommon disease in which patients have redundant colon. It commonly presents with constipation, lower abdominal pain and in severe cases, volvulus. Dolichocolon is an unusual cause of GERD. We present an unusual presentation of an uncommon pathology. Case Description/Methods: Our patient is 56-year-old woman presented with chronic cough and chronic abdominal pain. Initially patient was diagnosed with GERD. Fundoplication was planned since patient failed medical management. During workup, dolichocolon was discovered and after subtotal colectomy, the patient's symptoms of GERD resolved (Figure ). Discussion: Dolichocolon is defined as redundant colon. We can use the following criteria to diagnose it. • Sigmoid colon above the line between iliac crests.• Transverse colon below the aforementioned line.• Extra loops at the hepatic and splenic flexure. If all of the aforementioned redundancies are present at the same time a fully developed Dolichocolon is diagnosed. The reason for the redundant sigmoid colon is thought to be the pathological elongation of the hindgut and hence subsequently the elongation of the sigmoid colon. Although Dolichocolon largely is due to congenital malformation, there are certain theories that abnormal fecal transport, loss of Cajal cells and dietary habits also play a role in acquired dolichocolon. The imaging modality of choice for diagnosis is Barium enema, although we could still use computerized tomography, colonic transit study or magnetic resonance imaging. Our proposed theory for the cause of patient's symptoms is that the redundant colon increasing pressure on the stomach and hence resulting in symptoms of GERD. This case highlights the importance of Dolichocolon as a cause of abdominal complaints and presents an unusual presentation of a rare pathology.