Muhammad Tariq Baqai.
Duodenal tumors: unusual cause of iron deficiency anemia.
Pak Armed Forces Med J Jan ;55(4):364-5.

AA, 55 years old was admitted with complaints of backache of moderate intensity, abdominal pain and frequency of urine. Abdominal pain was not related to intake of food or time of day. There was no history of nausea, vomiting or alteration of bowel habits. He denied any history of loss of weight, malena or frank rectal bleed. On examination, the positive findings were pallor, koilonychia and soft palpable liver 2 cms below costal margin. On rectal examination, finger was stained with black coloured stool. Ultrasound of abdomen showed normal sized liver. Blood examination showed Hb. 6.1 Gm/ dl. MCV 65, MCH 20, reticulocyte count 1.8% ESR. 38 mm. Stool for occult blood was positive. Upper GI endoscopy showed no lesion in esophagus, stomach or bulb. In the second part of duodenum, multiple sessile polyps projecting into the lumen with ulceration of the surface were seen. Biopsy showed that stroma of the polyp, contained large number of neutrophils as well as glands lined by columnar epithelium. The impression was of multiple, ulcerating tubulo-villous adenoma. Surgery was advised but the patient refused.

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