BackgroundThere 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.CaseThe 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.ConclusionsPrimary 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.

From October 1978 to December 1982, we placed 86 Tenckhoff catheters in 69 patients of whom 64 completed training and were followed on CAPD. All catheters were either straight or pigtail double-cuff Quinton type. The devices were implanted by the surgeon in the operating room under local anesthesia with direct exposure of the peritoneum. Abdominal hernias have developed in eight patients; there have been six cuff erosions; seven patients developed fluid leaks; 18 catheters were removed. Mean catheter life was 20.6::!:: 10.3 months in the 15 catheters removed because of infectious complications and 6.9::!::6.7 months in four catheters removed for non-infectious complications.