| Summary: | Bleeding from the small intestine is an uncommon condition, of about 5%–10% of all gastrointestinal (GI) hemorrhages. Small intestinal malignancies (SIMs) are very rare, accounting for only 1% of the whole GI malignancies. SIM has few and nonspecific symptom and signs as iron deficiency anemia, weight loss, abdominal pain, and upper and lower GI bleeding. Usually, the diagnosis was delayed and most of them present in advances stage. GI stromal tumor, adenocarcinoma, carcinoid tumor, and lymphomas are among the common malignancies. Diagnosis of such cases is difficult as the upper and lower GI endoscopy often normal, capsule visualized endoscopy may show bleeding site and lesion, biopsy also a difficult issue as in our case. Here, we present a 44-year-old male patient who complained of lethargy and fatigue for 2 months duration. On physical examination, he was unremarkable apart from pallor. The initial investigations showed moderate hypochromic microcytic anemia, with low serum iron studies. The stool examination for occult blood was positive for that we did upper and lower GI endoscopy which was normal. On capsule visualized endoscopy revealed a bleeding small intestinal lesion (jejunum) later, we used pediatric colonoscopy for deep enteroscopy which was successful in identifying the lesion and biopsy took from the lesion confirming the diagnosis of GI adenocarcinoma. Surgical removal of tumor performed and the patient treated by oncologist after proper staging had been done. We emphasized that successful use of other diagnostic tools as using pediatric colonoscopy set for diagnosing such rare tumor is an option.
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