Small bowel adenocarcinoma – case report and literature review

Abstract

The authors present a theoretical review of small bowel neoplasm
based on a case report, of a 49-year-old man, with hypertension
and diabetes mellitus, whose diet included the main sources of
iron; without any previous surgeries. He presented progressive
fatigue, pallor, and reduced exercise capacity, without changing
bowel habits, apparent hematic stool losses or recent weight loss.
Laboratory studies showed: Hb 8.1g/dL; MCV 66.9 fl; MCH 19.8
pg; RDW 19%; anisocytosis and poikilocytosis; iron 16 mcg/dL;
transferrin 404 mg/dL; ferritin 2.75ng/mL; reticulocyte count
2.8%. The upper gastrointestinal endoscopy (UGI) and colonoscopy revealed no bleeding lesions. Hb level ranged between 8 and
13 g/dl, with low levels of ferritin even after parenteral iron therapy
was started. Additional tests carried out showed that antigliadin,
antiendomysial and anti-tissue transglutaminase antibodies were
negative, and an endoscopic biopsy of small intestine mucosa was
normal; fecal occult blood test was negative. Small bowel cineradiography showed an inflammatory aspect at duodenum and
jejunum, and a capsule endoscopy showed horseshoe necrotic
bleeding lesions at that level. Surgical exploration with enteroscopy defined a solitary lesion on the jejunum that was removed,
and a small bowel adenocarcinoma was identified in the biopsy.