A slow and silent return: a case of renal cell carcinoma recurring as gastrointestinal bleeding and small bowel obstruction.

Renal cell carcinoma (RCC) can metastasize years after treatment, with small bowel involvement being exceedingly rare. We report a 74-year-old man with RCC treated with nephrectomy and immunotherapy who presented ten years after clinical and radiologic remission with manifestations of metastatic disease in the small bowel. Specifically, he developed intussusception from a lead point lesion, followed by subsequent gastrointestinal (GI) bleeding and small bowel obstruction from another synchronous lesion. Each presentation required a distinct diagnostic and therapeutic approach. This case highlights the unpredictable course of RCC, underscoring the importance of comprehensive evaluation when patients with prior RCC develop new GI symptoms, regardless of time since treatment and historical remission.