Small Bowel Adenocarcinoma Presenting with Refractory Iron Deficiency Anemia – Case Report and Review of Literature

Abstract

Cancers of the small bowel are relatively rare and account for approximately 1–2% of all gastrointestinal neoplasms. The most common histologic subtype – adenocarcinoma – constitutes 40% of all cases. These cancers generally present with vague abdominal discomfort and are often diagnosed at a late stage and carry a poor prognosis. The treatment of choice of early-stage small bowel adenocarcinoma is surgical resection. No standard treatment protocol has been defined for unresectable or metastatic disease. Here, we report a case of a 56-year-old woman who presented with unexplained iron deficiency anemia. Extensive initial studies with serial CT scans of the abdomen, esophagogastroduodenoscopy, small bowel capsule endoscopy and colonoscopy were noncontributory. She was later found to have a metastatic small bowel adenocarcinoma and treated with palliative chemotherapy. She achieved a modest response to the treatment. Interestingly, in our case, the sole presentation was unexplained iron deficiency anemia. Physician’s awareness regarding the possibility of small bowel cancer especially in the setting of iron deficiency and its workup has been emphasized. This enhances the chance of early detection and hence better survival.

Small bowel adenocarcinoma - terra incognita: A demand for cross-national pooling of data

“…Accordingly, Poddar et al recently emphasized the importance of considering SBA as a possible underlying cause of unexplained iron deficiency anemia (1). …”

“…Adenocarcinoma is the most common histopathological subtype (1), followed by carcinoid tumors, lymphomas and sarcomas (2,3). …”

“…Thus, despite increasing advantages in radiographic imaging, early detection of small bowel neoplasms remains infrequent and the majority of patients present with already unresectable or metastatic disease (1). Due to the rarity of these tumors, there is an ongoing lack of sufficient data characterizing this patient population adequately.…”

Intestinal obstruction caused by small bowel adenocarcinoma misdiagnosed as psychogenic disorder

“…The incidence of small bowel neoplasms is very rare and accounts for only 1%–3% of all gastrointestinal tumours 1–7. Among them, small bowel adenocarcinoma (SBA) is the most common type, comprising approximately 25%– 40% of all small bowel tumours 1–3 5–7. Despite recent advances in radiographic imaging and endoscopic techniques, early detection of small bowel tumours is still low owing to the vague and non-specific nature of the initial symptoms 1 3.…”

“…Among them, small bowel adenocarcinoma (SBA) is the most common type, comprising approximately 25%– 40% of all small bowel tumours 1–3 5–7. Despite recent advances in radiographic imaging and endoscopic techniques, early detection of small bowel tumours is still low owing to the vague and non-specific nature of the initial symptoms 1 3. Because small bowel tumours are so rare, patients who present with nausea and abdominal pain are occasionally misdiagnosed as having psychogenic disorder because the cause of their symptoms is not identified.…”