What’s Your Diagnosis?
By Stephanie Judd, M.D., and Fadi Antaki, M.D.
A rare finding on evaluation for iron-deficiency anemia
A53-year-old man with no significant past medical history was referred to gastroenterology for evalu- ation of iron-deficiency anemia. He denied melena, hematochezia, hematemesis, or any overt bleeding. He denied abdominal pain, dyspepsia, chest pain, or shortness of breath; complete review of systems
What is the diagnosis, and how should it be managed?
was negative. General physical examination was within nor-
mal limits. Initial work-up included esophagogastroduode-
noscopy, which was normal, and colonoscopy, which showed
two adenomatous polyps. Video capsule endoscopy was
subsequently completed, which showed possible extrinsic
compression versus submucosal mass in the middle third of
the small bowel. To further evaluate these video capsule en-
doscopy findings, computed tomography enterography was
performed (Figures A–D). n
Dr. Judd and Dr. Antaki are with the division of gastroenterology at the John D. Dingell VA Medical Center and Wayne
State University in Detroit. Dr. Judd is also with the Detroit
See The Answer on page 14
Published previously in Gastroenterology (2014;146:e8-9)