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Case Reports
. 2024 Apr 26;14(9):904.
doi: 10.3390/diagnostics14090904.

Obscure Bleeding from a Metastatic Small Bowel Tumor Diagnosed Using Motorized Spiral Enteroscopy: A Case Study and a Literature Review

Christian Banciu  1 , Andreea Munteanu  1 , Adrian Aprotosoaie  1 , Ramona Fabian  1 , Amadeus Dobrescu  2 , Adrian Vaduva  3   4   5 , Antonio Fabian  6 , Irina Soica  7 , Viviana Ivan  8 , Laurentiu Sima  9
Affiliations
Case Reports

Obscure Bleeding from a Metastatic Small Bowel Tumor Diagnosed Using Motorized Spiral Enteroscopy: A Case Study and a Literature Review

Christian Banciu et al. Diagnostics (Basel). .

Abstract

Small bowel tumors are relatively rare, representing only around 5% of all gastrointestinal neoplasms, with a progressively increasing incidence. Currently, there are no established guidelines for diagnostic approaches, screening procedures, or management strategies for small bowel tumors. We present here the case of a patient with a rare type of metastatic tumor of the small bowel originating from primary lung adenocarcinoma who presented with abdominal pain, severe iron-deficiency anemia, and melena. The initial investigations, gastroscopy and colonoscopy, failed to identify the bleeding source. The obscure bleeding source and diagnosis were achieved through power motorized spiral enteroscopy (MSE), which allowed the visualization and biopsy of the tumor. Histopathological examination established the presence of a poorly differentiated non-mucinous adenocarcinoma originating from the lung. This case is reported to provide evidence of the efficiency of MSE in the diagnosis of small bowel tumors, with the method providing higher insertion depth in a reduced amount of time.

Keywords: motorized spiral enteroscopy (MSE); obscure bleeding; primary lung adenocarcinoma; small bowel tumors.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Enteroscopic view showing the bleeding ileal tumor lesion.
Figure 2
Figure 2
Axial CT sections showing a spiculated lesion in the LSL (A), a lesion in the LLL (B), the presence of a left-sided calcified pachypleuritis (C,D) and mediastinal adenopathies (E).
Figure 3
Figure 3
Sample H&E-stained section showing a poorly differentiated malignant tumor, composed of round to cuboidal cells, arranged in solid and trabecular patterns. The nuclei are enlarged, pleomorphic, and vesiculous, with prominent nuclei. Atypical mitoses and necrosis are present (20× magnification).
Figure 4
Figure 4
Immunohistochemical reaction for CK7 shows intense, diffuse staining in tumor cells (20× magnification).
Figure 5
Figure 5
Immunohistochemical reaction for TTF1 shows intense, diffuse, nuclear staining in tumor cells (20× magnification).
See this image and copyright information in PMC

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