Introduction: Small-bowel adenocarcinoma is a rare malignancy that may present with gastrointestinal bleeding and severe anaemia, often with delayed diagnosis because the small bowel is difficult to evaluate using conventional endoscopy. Multifocal intestinal tumours in patients with previous gynaecological malignancy create an additional diagnostic challenge in distinguishing primary from metastatic disease.
Case Presentation: A 70-year-old woman with recently diagnosed serous endometrial carcinoma presented with four months of recurrent melena, profound anaemia (haemoglobin 4.4 g/dL), weight loss and weakness. Upper gastrointestinal endoscopy and colonoscopy failed to identify the bleeding source. Computed tomography revealed a large exophytic intra-abdominal mass and additional pelvic and lymph-node lesions, initially considered suggestive of a gastrointestinal stromal tumour or other mesenchymal neoplasm. Exploratory laparotomy demonstrated three intra-abdominal tumours, including a large proximal jejunal mass adherent to the colon, a second inter-loop intestinal tumour and a third pelvic tumour was adherent to the urinary bladder and anterior abdominal wall. Segmental jejunal resection and left hemicolectomy were performed. Histopathology revealed papillary adenocarcinoma. Immunohistochemical evaluation was not performed because of the patient’s rapid postoperative deterioration. She subsequently developed persistent hypoxaemia and died postoperatively.
Conclusion: Small-bowel malignancy should be considered in patients with recurrent melena and severe anaemia despite negative conventional endoscopy. Multifocal intestinal tumours in patients with previous endometrial carcinoma require careful consideration of both primary small-bowel adenocarcinoma and metastatic disease. Histopathology, supported by appropriate immunohistochemistry, is essential for establishing tumour origin and guiding management.