Small-intestinal bleeding due to metastatic renal cell cancer.

obscure occult gastrointestinal bleeding was referred to our department to undergo capsule endoscopy. He had a history of clear-cell renal carcinoma (pT2NxM0EII), for which he had undergone a radical nephrectomy 1 year before. No adjuvant radiation or chemotherapy was administered. At 5 days before capsule endoscopy was due to be performed, he developed melena and required blood transfusion. Laboratory data revealed an iron deficiency anemia, with a hemoglobin level of 7.8 g/dL. Capsule endoscopy of the small bowel revealed an active hemorrhage due to an ulcerated mass at the proximal jejunum (●" Fig. 1). Enteroscopy confirmed the bleeding tumor, which was excised immediately (●" Video 1). The pathology was consistent with clearcell renal metastases to the small bowel. Secondary tumors of the gastrointestinal tract are unusual but are probably more common than clinically suspected. The most common primaries include melanoma, lung, breast, and ovarian carcinomas, and choriocarcinomas. Intraluminal small-bowelmetastases from metastatic renal cancer are not commonly seen, but based on autopsy data the incidence may be 0.7%–14.6% [1–4]. The interval from initial nephrectomy to presentation of intestinal metastases is reported to range from 3months to 20 years, and appears to correlate with overall disease-specific survival. Intestinal metastases occur equally in the jejunum and the ileum, and usually present with intestinal bleeding due to tumoral invasion of intestinal vessels [5]. This current case is of interest because its demonstrates the clinical and endoscopic characteristics of an unusual small-bowel tumor. Capsule endoscopy allowed not only the detection of the site of active bleeding but also the diagnosis of the intestinal mass. The early use of this device shortened the patient’s diagnostic work-up and subsequent management.