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Rare case of small intestine bleeding
  1. Jeremy D Cumberledge,
  2. Ikenna Anaka and
  3. Justin T Kupec
  1. Department of Medicine, Section of Digestive Diseases, West Virginia University Hospitals, Morgantown, West Virginia, USA
  1. Correspondence to Justin T Kupec, jkupec{at}


We present a case of a healthy 59-year-old woman who presented for a capsule endoscopy to evaluate melaena and iron deficiency anaemia. She had previously underwent an oesophagogastroduodenoscopy and colonoscopy at an outside institution which were unremarkable. Capsule endoscopy showed an ulcerated, bleeding lesion likely in the duodenum. Differential diagnosis included adenocarcinoma, carcinoid tumour, lymphoma, gastrointestinal stromal tumour and metastatic disease. A push enteroscopy was performed after which showed an ulcerated mass in the third portion of the duodenum. Biopsies confirmed adenocarcinoma. Computed tomography of the abdomen showed no signs of distant metastasis and the patient was referred to surgery for evaluation. The patient underwent a pancreaticoduodenectomy, with resection of the mass and negative lymph nodes in all nine that were removed (T3N0). The patient was classified as stage II duodenal adenocarcinoma. Duodenal adenocarcinoma is a rare but clinically significant cause of small bowel bleeding.

  • gastroenterology
  • gi bleeding
  • small intestine

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  • Contributors JDC was involved in direct patient care, obtaining of consent for the case report, planning, writing and editing the above report. IA was involved in direct patient care, planning, writing and editing the above report. JTK was involved in direct patient care, planning, writing and editing the above report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.