Finding a Diagnosis in Obscure Gastrointestinal Bleeding: A Case of Small Bowel Neuroendocrine Tumor

Small bowel or mid-gut gastrointestinal (GI) bleeding has been historically difficult to diagnose and is believed to be the main culprit of what was once termed obscure GI bleeding. Small bowel bleeding is difficult to evaluate due to its inaccessibility by direct visualization. Due to recent innovations in diagnostic techniques such as video capsule endoscopy (VCE), deep enteroscopy, and CT enterography, the capability to visualize and diagnose pathologies within the small bowel has improved. One such pathology is neuroendocrine tumors (NETs), which in recent years have overtaken adenocarcinoma as the most common malignancy of the small intestine. Early-stage small bowel neuroendocrine tumors (SBNETs) in the jejunal-ileum are difficult to detect due to their indolent nature and are often found only after they metastasize. We describe a case of small bowel GI bleeding in a functional 90-year-old patient where methodological use of advanced diagnostic modalities with video capsule endoscopy and double balloon enteroscopy helped identify an early-stage SBNET of the jejunal-ileum, leading to timely surgical intervention.