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


METHODS
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.
Kalogerinis
Peter T
PT
Methodist University Physician Assistant Program, Fayetteville, North Carolina, USA.
Poulos
John E
JE
Morfesis
Andrew
A
Daniels
Anthony
A
Georgakila
Stavroula
S
Daignualt
Thomas
T
Georgakilas
Alexandros G
AG
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis*; D003937:Diagnosis, Differential; D004379:Duodenal Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery; D004384:Duodenoscopy; D005260:Female; D006801:Humans; D007813:Laparotomy; D008022:Ligaments; D014057:Tomography, X-Ray Computed
D014408:Biomarkers, Tumor