A case report of multiple primary small bowel adenocarcinoma in young male

A 34 year old man presented with melena and features of anaemia for 2 months duration. He didnt have abdominal pain or distension, vomiting or borborygmi. His physical examination was normal except for pallor. Abdominal examination didnt reveal any significant findings. On work up his hemoglobin was 5 gdl, renal and liver function tests were normal. Platelet count and coagulation profile was normal. Ultrasound abdomen didnt reveal any significant abnormality. Patient was stabilized with blood transfusions. Oesophago-gastroduo denoscopy and colonoscopy was normal and presented as obscure gastrointestinal bleed. Since patient had persistent melena single balloon enteroscopy was done which revealed a nodular elevated lesion with active bleeding in proximal jejunum suspected as a vascular lesion. Since patient had active bleeding from the lesion, argon plasma coagulation of lesion done and biopsy of lesion was taken as liver had lesions suggestive of secondaries. Since the patient had persistent bleeding in spite of argon plasma coagulation of lesion and biopsy suggestive of poorly differentiated adenocarcinoma he was taken up for surgery which revealed four lesions starting from duodeno-jejunal flexure to terminal jejunum with adjacent mesenteric node involvement. Enterotomy of first and fourth lesion was done. Since the second and third lesions were adjacent, resections with intervening segment of bowel with adjacent mesenteric nodes done. During surgery liver showed nodular elevated lesion and biopsy was suggestive of secondaries. Post surgery patient is on chemotherapy now. This case is reported since multiple small bowel carcinomas in young are rarely reported in literature. Also obscure gastrointestinal bleed require extensive work up and possible small bowel source should not be neglected.