Letter to the Editors Double-balloon Enteroscopy in the Diagnosis of an Adenocarcinoma of the Fourth Portion of the Duodenum: Report of a Case

Primary adenocarcinoma of the duodenum is a rare condition representing around 0.5% of all gastrointestinal tract cancers. 1-5 Adenocarcinomas are the most common histological type of malignant neoplasms of the duodenum accounting for 50% of the cases, followed by carcinoid, leiomyosarcomas and lymphomas. 4,6-8 Adenocarcinoma of the duodenum usually occurs between the sixth and seventh decades, and equal sex distribution is reported in the majority of the studied series. The second duodenal portion has the highest incidence of adenocarcinoma representing 74% of the cases, followed by third (13%), fourth (9%) and first (4%) portions. The diagnosis of this disease is often delayed because symptoms and signs are nonspecific and vague, similar to those found in many benign conditions. In cases comprehending the third and fourth portions of the duodenum, the diagnosis may be even more delayed because endoscopic examination of the distal duodenum is poorly accomplished. We report a case of a 41-year-old man with primary adenocarcinoma of the fourth portion of the duodenum who presented with anemia and abdominal pain. His final diagnosis was confirmed with histological examination of biopsies performed through double-balloon enteroscopy (DBE).