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A Case of Primary Duodenal Cancer on Afferent Loop Presenting with Chronic Anemia and Recurrent Melena

Obscure gastrointestinal bleeding accounts for approximately 5% of all gastrointestinal bleeding. Angioectasia of the small bowel is the most common form of obscure gastrointestinal bleeding, while small bowel tumors are the second. Among small bowel tumors, primary duodenal cancer is uncommon and represents 0.3% of gastrointestinal tumors. However, primary duodenal cancer at the duodenal stump following Billroth II gastrectomy for stomach cancer is extremely rare, and have not been reported yet in Korea. We report the first case of a 74-year-old man with chronic anemia and recurrent melena, which was diagnosed as a primary duodenal adenocarcinoma developed in afferent loop. The primary lesion was successfully accessed under cap-fitted endoscopy, however final diagnosis was delayed due to the unusual anatomical site.