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Open Access Highly Accessed Case report

Duodenal carcinoma at the ligament of Treitz. A molecular and clinical perspective

Peter T Kalogerinis1, John E Poulos2, Andrew Morfesis3, Anthony Daniels2, Stavroula Georgakila4, Thomas Daignualt2 and Alexandros G Georgakilas5*

Author Affiliations

1 Methodist University Physician Assistant Program, Fayetteville, North Carolina, USA

2 Fayetteville Gastroenterology Associates, Fayetteville, North Carolina, USA

3 Owen Drive Surgical Clinic of Fayetteville, Fayetteville, North Carolina, USA

4 Harris Birthright Research Centre for Fetal Medicine, Department of Obstetrics and Gynecology, Kings College University Hospital, London SE5 9SR, UK

5 Department of Biology, Thomas Harriot College of Arts and Sciences, East Carolina University, Greenville, North Carolina 27858, USA

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BMC Gastroenterology 2010, 10:109  doi:10.1186/1471-230X-10-109

Published: 17 September 2010

Abstract

Background

There is very small occurrence of adenocarcinoma in the small bowel. We present a case of primary duodenal adenocarcinoma and discuss the findings of the case diagnostic modalities, current knowledge on the molecular biology behind small bowel neoplasms and treatment options.

Case

The patient had a history of iron deficiency anemia and occult bleeding with extensive workup consisting of upper endoscopy, colonoscopy, capsule endoscopy, upper gastrointestinal series with small bowel follow through and push enteroscopy. Due to persistent abdominal pain and iron deficiency anemia the patient underwent push enteroscopy which revealed adenocarcinoma of the duodenum. The patient underwent en-bloc duodenectomy which revealed T3N1M0 adenocarcinoma of the 4th portion of the duodenum.

Conclusions

Primary duodenal carcinoma, although rare should be considered in the differential diagnosis of occult gastrointestinal bleeding when evaluation of the lower and upper GI tract is unremarkable. We discuss the current evaluation and management of this small bowel neoplasm.