Diagnosing jejunal adenocarcinoma in a man with severe iron deficiency anemia using pediatric colonoscopy set

Abstract

Bleeding from the small intestine is an uncommon condition, of about 5%–10% of all gastrointestinal (GI)hemorrhages. Small intestinal malignancies (SIMs) are very rare, accounting for only 1% of thewhole GI malignancies. SIM has few and nonspecific symptom and signs as iron deficiency anemia,weight loss, abdominal pain, and upper and lower GI bleeding. Usually, the diagnosis was delayedand most of them present in advances stage. GI stromal tumor, adenocarcinoma, carcinoid tumor,and lymphomas are among the common malignancies. Diagnosis of such cases is difficult as theupper and lower GI endoscopy often normal, capsule visualized endoscopy may show bleeding siteand lesion, biopsy also a difficult issue as in our case. Here, we present a 44‑year‑old male patientwho complained of lethargy and fatigue for 2 months duration. On physical examination, he wasunremarkable apart from pallor. The initial investigations showed moderate hypochromic microcyticanemia, with low serum iron studies. The stool examination for occult blood was positive for that wedid upper and lower GI endoscopy which was normal. On capsule visualized endoscopy revealed ableeding small intestinal lesion (jejunum) later, we used pediatric colonoscopy for deep enteroscopywhich was successful in identifying the lesion and biopsy took from the lesion confirming the diagnosisof GI adenocarcinoma. Surgical removal of tumor performed and the patient treated by oncologistafter proper staging had been done. We emphasized that successful use of other diagnostic toolsas using pediatric colonoscopy set for diagnosing such rare tumor is an option.