Enteroscopic identification of an adenocarcinoma of the small bowel in a patient with previously unrecognized hereditary nonpolyposis colorectal cancer syndrome

Tumors of the small bowel are uncommon and seldom suspected on a clinical b asis. Together with the relative inaccessibility of the small bowel to endo scopic investigation, the rarity of these rumors undoubtedly delays their d iagnosis. The case reported is of a patient with an adenocarcinoma of the j ejunum presenting as gastrointestinal bleeding of obscure origin. Diagnosis was by push enteroscopy, after several years of unsuccessful radiological and upper and lower endoscopic evaluation. The patient's family fulfilled t he Amsterdam criteria for hereditary nonpolyposis colorectal cancer syndrom e, which was previously unrecognized. This report emphasizes the value of p ush enteroscopy and the limits of radiography of the small bowel when inves tigating patients with obscure GI bleeding. It also underlines the importan ce of a careful evaluation of the pedigree (concerning history of colorecta l and exhacolonic cancer) of all patients, including those who present with adenocarcinoma of the small bowel; it is similarly important to consider t he possibility of small bowel cancer in members of families with hereditary nonpolyposis colorectal cancer (HNPCC)syndrome. (Am J Gastroenterol 1999;9 4: 1962-1966. (C) 1999 by Am. Coll. of Gastroenterology).