NOT``JUST ANOTHER GI BLEED''! A. Krishnamurthy 1 , R. Ruffner 1 , D. Weber 1 ; 1 University of Pittsburgh Medical Center Shadyside, Pittsburgh, PA LEARNING OBJECTIVES: 1) Consider small bowel tumors in the evaluation of GI bleeding with the upper endoscopy and colonoscopy are negative. 2) Small bowel series, enteroclysis and enteroscopy have a role in their diagnosis. CASE INFORMATION: 84-year-old Asian male presented with his second episode of melena. He also complained of``fullness of the abdomen after meals''. He had no nausea, vomiting, abdominal pain, constipation or diarrhea. The patient had been admitted two weeks before with melena and anemia requiring blood transfusions. He had both upper DI endoscopy (showed mild esophagitis) and colonoscopy (showed two polyps). PMH of hypertension. His medications included iron, famotidine and Metoprolol. He did not smoke or abuse alcohol. ROS: Negative. Examination: His temperature was 36.8, pulse 72 bpm, BP 120/60 and was not orthostatic. His conjuntiva was pale. Abdomen was soft with normal bowel sounds, no tenderness, no masses, liver/spleen not palpable. Rectal exam reveled heme positive stool. Examination of all other systems was normal. Labs: WBC 5.4, Hemoglobin 8.9, BUN 42 & Cretinine 1.2, Iron 28, TIBC 258 Ferritin 25. Small bowel entersocopy was normal upto the duodenum but the scope could not be advanced beyond the fourth part of duodenum because of narrowing. Small bowel follow through shoed an apple-core defect at the duodeno-jejunal junction. Surgical resection of lesion confirmed a 4-cm adenocarcinoma of jejunum without lympnode involvement. DISCUSSION: Small bowel neoplasms are relatively uncommon. Small bowel accounts for less than 3% of GI malignancies despite contributing to more than 90% of the surface area of GI tract. The possible reasons are: