Rationale: Sarcomatoid carcinoma of the small intestine is an exceedingly rare and aggressive malignancy, often diagnosed at advanced stages with a poor prognosis. This study documents a detailed case of sarcomatoid carcinoma of the small intestine, highlighting the diagnostic challenges and treatment approaches, underscored by a comprehensive review of related literature. Given the rarity of this condition, our report aims to enrich the existing diagnostic and treatment frameworks for this malignancy, emphasizing the necessity for early detection and intervention strategies. By presenting this case in conjunction with a literature review, we seek to shed light on the elusive nature of sarcomatoid carcinoma in the small intestine and propose avenues for improving patient outcomes. Patient concerns: Case presentation A 61-year-old male patient initially presented with recurrent abdominal pain and gastrointestinal symptoms. Initial abdominal computed tomography (CT) scans and gastrointestinal endoscopy revealed only inflammatory and hyperplastic changes in the duodenum and jejunum, with a diagnosis of intestinal obstruction. Two years later, due to gastrointestinal perforation, the patient was hospitalized again. Diagnoses: CT scans and other examinations revealed small intestinal lesions. Four small intestinal lesions were surgically removed, and pathology and immunohistochemistry confirmed sarcomatoid carcinoma of the small intestine. A short time later, enhanced CT scans revealed metastatic lesions in the hepatic portal and adrenal glands. Interventions: After surgery, the gastrointestinal function gradually recovered, and the patient was discharged from the hospital on a semiliquid diet. No further treatment such as radiotherapy or chemotherapy was administered postoperatively. Outcomes: Five months after the surgery, the patient died due to brain metastasis. Lessons: The study outcomes reveal the aggressive nature of sarcomatoid carcinoma of the small intestine, characterized by rapid progression and poor prognosis despite surgical interventions. The patient condition rapidly deteriorated, leading to metastasis and death within 5 months postsurgery. These findings underscore the critical need for early detection and possibly innovative treatment approaches to improve survival rates. This case also highlights the potential for gastrointestinal sarcomatoid carcinoma to metastasize to distant organs, including the brain, suggesting a propensity for hematogenous spread.

<h4>Background</h4>Eosinophilic enteritis is a rare subtype of eosinophilic gastrointestinal disorders characterized by eosinophilic infiltration of the small intestine. Clinical presentation varies according to the depth of bowel wall involvement. Muscularis-predominant disease is exceptionally uncommon and frequently lacks peripheral eosinophilia, which poses considerable preoperative diagnostic difficulty.<h4>Case presentation</h4>A 23-year-old woman presented with acute severe upper-quadrant abdominal pain, nausea, and vomiting, on a background of three similar hospitalizations over two years without a definitive diagnosis. Imaging showed segmental ileal narrowing with proximal small-bowel dilatation and ascites. Laboratory testing revealed leukocytosis without peripheral eosinophilia. Because of persistent obstruction, a limited right hemicolectomy with ileal resection was performed. Histopathology demonstrated dense eosinophilic infiltration (markedly increased, exceeding 50 eosinophils per high-power field) predominantly involving the muscularis propria and subserosa, with preserved mucosa. Peritoneal biopsies showed eosinophilic inflammation. Malignancy, tuberculosis, vasculitis, and parasitic infection were excluded. Postoperative recovery was uneventful.<h4>Conclusion</h4>Eosinophilic enteritis should be considered in the differential diagnosis of recurrent abdominal pain and small-bowel obstruction, even when peripheral eosinophilia is absent. Histopathological examination is essential for definitive diagnosis, and awareness is particularly important in resource-limited settings where advanced diagnostic modalities are unavailable.

Abdominal trauma is present in approximately 25% of pediatric patients with major trauma and is the most common cause of unrecognized fatal injury in children. Pediatric abdominal trauma is typically blunt in nature with the spleen being the most common organ injured. Nonoperative management is employed in over 95% of patients. Penetrating injuries are less common but often require operative management. Knowledge of specific mechanisms of injury aids the clinician in the diagnosis of specific injuries. Computed Tomography (CT) is the gold standard in the identification of intra-abdominal injury. Focused Assessment with Sonography for Trauma (FAST) can detect the presence of free fluid suggestive of intra-abdominal injury. In children, the utility of FAST is limited because less than half of pediatric patients with abdominal injury have free fluid. Bowel perforation and pancreatic injuries may not be evident on initial CT scanning of the abdomen. Initial management of the trauma patient in shock includes fluid boluses of normal saline or Ringer's lactate with two, large-bore upper extremity catheters. Transfusion with packed red blood cells is done if the patient remains hypotensive after the second fluid bolus. Emergent laparotomy is indicated in patients with: free intraperitoneal air, hemodynamic instability despite maximal resuscitative efforts (transfusion of greater than 50% of total blood volume), gunshot wound to the abdomen or other penetrating traumas, and evisceration of intraperitoneal contents. Initial FAST followed by abdominal computed tomography is important in the evaluation of the seriously or critically injured patient. The combination of the FAST exam along with selected abdominal computed tomography can further aid in the detection of injuries that may not be clinically apparent.

<h4>Background</h4>Fish bone ingestion is a common clinical problem. However, occult ingestion causing concurrent gastric bleeding and jejunal perforation is extremely rare and easily misdiagnosed.<h4>Case presentation</h4>A 72-year-old male presented with upper abdominal pain and hematemesis with no clear history of foreign body ingestion. Abdominal CT revealed a high-density shadow in the stomach, localized gas-fluid accumulation in the small intestine, and minimal surrounding exudation. Emergency gastroscopy failed to identify the source of bleeding. The patient subsequently developed peritonitis, and emergency laparotomy revealed a migratory fish bone that had penetrated the gastric wall and caused secondary jejunal perforation. The patient recovered uneventfully after removal of the fish bone and partial jejunal resection.<h4>Discussion</h4>The mechanism underlying this cross-site injury is as follows: the fish bone first pierced the gastric wall, causing gastric bleeding; it then penetrated the full thickness of the gastric wall and entered the peritoneal cavity, triggering peritonitis; finally, the migrating fish bone punctured the jejunal wall, leading to jejunal perforation and aggravated intra-abdominal inflammation.<h4>Conclusion</h4>In elderly patients with abdominal pain and hematemesis but no clear history of foreign body ingestion, rapidly elevated inflammatory markers, progressive peritoneal irritation, and negative gastroscopy should raise strong suspicion of occult fish bone-induced cross-site gastrointestinal injury (gastric bleeding and jejunal perforation). Timely laparotomy is critical for definitive diagnosis and improved prognosis in patients with peritonitis secondary to jejunal perforation. This case provides valuable clinical insights for the early diagnosis and management of similar atypical gastrointestinal injuries caused by fish bone ingestion.