{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:38:51Z","timestamp":1787027931068,"version":"build-2736575974"},"reference-count":32,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T00:00:00Z","timestamp":1714089600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Small bowel tumors are relatively rare, representing only around 5% of all gastrointestinal neoplasms, with a progressively increasing incidence. Currently, there are no established guidelines for diagnostic approaches, screening procedures, or management strategies for small bowel tumors. We present here the case of a patient with a rare type of metastatic tumor of the small bowel originating from primary lung adenocarcinoma who presented with abdominal pain, severe iron-deficiency anemia, and melena. The initial investigations, gastroscopy and colonoscopy, failed to identify the bleeding source. The obscure bleeding source and diagnosis were achieved through power motorized spiral enteroscopy (MSE), which allowed the visualization and biopsy of the tumor. Histopathological examination established the presence of a poorly differentiated non-mucinous adenocarcinoma originating from the lung. This case is reported to provide evidence of the efficiency of MSE in the diagnosis of small bowel tumors, with the method providing higher insertion depth in a reduced amount of time.<\/jats:p>","DOI":"10.3390\/diagnostics14090904","type":"journal-article","created":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T08:42:57Z","timestamp":1714639377000},"page":"904","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Obscure Bleeding from a Metastatic Small Bowel Tumor Diagnosed Using Motorized Spiral Enteroscopy: A Case Study and a Literature Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5049-9861","authenticated-orcid":false,"given":"Christian","family":"Banciu","sequence":"first","affiliation":[{"name":"Department of Internal Medicine IV, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5562-5855","authenticated-orcid":false,"given":"Andreea","family":"Munteanu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine IV, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Aprotosoaie","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine IV, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramona","family":"Fabian","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine IV, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amadeus","family":"Dobrescu","sequence":"additional","affiliation":[{"name":"Department of Surgery II, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9261-5309","authenticated-orcid":false,"given":"Adrian","family":"Vaduva","sequence":"additional","affiliation":[{"name":"Department of Microscopic Morphology-Morphopatology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"ANAPATMOL Research Center, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Department of Pathology, \u201cPius Brinzeu\u201d County Clinical Emergency Hospital, 300723 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Fabian","sequence":"additional","affiliation":[{"name":"Clinical Hospital of Infectious Diseases and Pneumophysiology Dr. Victor Babe\u0219 Timi\u0219oara, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Soica","sequence":"additional","affiliation":[{"name":"Medical School, University College London, 74 Huntley St., London WC1E 6DE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4304-4911","authenticated-orcid":false,"given":"Viviana","family":"Ivan","sequence":"additional","affiliation":[{"name":"Department of Cardiology I, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2854-7449","authenticated-orcid":false,"given":"Laurentiu","family":"Sima","sequence":"additional","affiliation":[{"name":"Department of Surgical Semiology I and Thoracic Surgery, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"413","DOI":"10.4251\/wjgo.v14.i2.413","article-title":"Small bowel adenocarcinoma: An overview","volume":"14","author":"Khosla","year":"2022","journal-title":"World J. Gastrointest. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1102\/1470-7330.2006.0031","article-title":"Diagnosis and staging of small bowel tumours","volume":"6","author":"Gore","year":"2006","journal-title":"Cancer Imaging"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"101860","DOI":"10.1016\/j.bpg.2023.101860","article-title":"Updates in the diagnosis and management of small-bowel tumors","volume":"64\u201365","author":"Vlachou","year":"2023","journal-title":"Best Pract. Res. Clin. Gastroenterol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e148","DOI":"10.1002\/deo2.148","article-title":"Safety and efficacy of the novel motorized power spiral enteroscopy: A single-center experience","volume":"3","author":"Singh","year":"2023","journal-title":"DEN Open"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"W197","DOI":"10.2214\/AJR.08.1907","article-title":"Gastrointestinal Metastasis from Primary Lung Cancer: CT Findings and Clinicopathologic Features","volume":"193","author":"Kim","year":"2009","journal-title":"Am. J. Roentgenol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"350","DOI":"10.5217\/ir.2015.13.4.350","article-title":"Small Bowel Metastatic Cancer Observed with Double Balloon Enteroscopy in a Patient with a Past History of Multiple Cancers","volume":"13","author":"Song","year":"2015","journal-title":"Intest. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1186\/s12957-016-0932-3","article-title":"Small bowel adenocarcinoma of the jejunum: A case report and literature review","volume":"14","author":"Li","year":"2016","journal-title":"World J. Surg. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"319","DOI":"10.21147\/j.issn.1000-9604.2020.03.04","article-title":"Impact of enteroscopy on diagnosis and management of small bowel tumors","volume":"32","author":"Ribeiro","year":"2020","journal-title":"Chin. J. Cancer Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/S0016-5085(00)70430-6","article-title":"AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding","volume":"118","author":"Zuckerman","year":"2000","journal-title":"Gastroenterology"},{"key":"ref_10","first-page":"875","article-title":"A new view of occult and obscure gastrointestinal bleeding","volume":"69","author":"Mitchell","year":"2004","journal-title":"Am. Fam. Physician."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1159\/000488479","article-title":"Motorized Spiral Enteroscopy for Occult Bleeding","volume":"36","author":"Mans","year":"2018","journal-title":"Dig. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1016\/j.gie.2020.10.028","article-title":"Total motorized spiral enteroscopy: First prospective clinical feasibility trial","volume":"93","author":"Beyna","year":"2021","journal-title":"Gastrointest. Endosc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1097\/MCG.0000000000001862","article-title":"Role of Novel Motorized Enteroscopy in the Evaluation of Small Bowel Diseases","volume":"58","author":"Nabi","year":"2024","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1007\/s10620-022-07688-1","article-title":"Motorized Spiral Enteroscopy Is Effective in Patients with Prior Abdominal Surgery","volume":"68","author":"Giordano","year":"2023","journal-title":"Dig. Dis. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/j.vgie.2020.08.001","article-title":"A spiraling journey into the small bowel: A case series of novel motorized power spiral enteroscopies","volume":"5","author":"Prasad","year":"2020","journal-title":"VideoGIE"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.tgie.2007.12.005","article-title":"Complications of Double Balloon Enteroscopy","volume":"10","author":"Mensink","year":"2008","journal-title":"Tech. Gastrointest. Endosc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"AB127","DOI":"10.1016\/j.gie.2009.03.152","article-title":"Severe Complications of Spiral Enteroscopy in the First 1750 Patients","volume":"69","author":"Akerman","year":"2009","journal-title":"Gastrointest. Endosc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1855","DOI":"10.14309\/ajg.0000000000002409","article-title":"A Randomized, Controlled Trial Comparing the Total Enteroscopy Rate and Diagnostic Efficacy of Novel Motorized Spiral Enteroscopy and Single-Balloon Enteroscopy in Patients with Small-Bowel Disorders: The Motor Trial (NCT 05548140)","volume":"118","author":"Rughwani","year":"2023","journal-title":"Am. J. Gastroenterol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1080\/00365521.2023.2212311","article-title":"Motorized spiral enteroscopy\u2014A prospective analysis of 82 procedures at a single tertiary center","volume":"58","author":"Falt","year":"2023","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"6998","DOI":"10.1007\/s00464-023-10179-7","article-title":"Effectiveness and safety of novel motorized spiral enteroscopy: A systematic review and meta-analysis","volume":"37","author":"Wang","year":"2023","journal-title":"Surg. Endosc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e13469","DOI":"10.1097\/MD.0000000000013469","article-title":"Perforation of small intestine secondary to metastatic lung adenocarcinoma","volume":"97","author":"Wang","year":"2018","journal-title":"Medicine"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Barsouk, A., Rawla, P., Barsouk, A., and Thandra, K.C. (2019). Epidemiology of Cancers of the Small Intestine: Trends, Risk Factors, and Prevention. Med. Sci., 7, Available online: https:\/\/www.mdpi.com\/2076-3271\/7\/3\/46.","DOI":"10.3390\/medsci7030046"},{"key":"ref_23","first-page":"9766","article-title":"Gastrointestinal metastasis of primary lung cancer: An analysis of 366 cases","volume":"15","author":"Hu","year":"2018","journal-title":"Oncol. Lett."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/1477-7800-2-13","article-title":"Frequency, symptoms and outcome of intestinal metastases of bronchopulmonary cancer. Case report and review of the literature","volume":"2","author":"Hillenbrand","year":"2005","journal-title":"Int. Semin. Surg. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1159\/000523663","article-title":"Small-Intestinal Metastasis from Lung Carcinoma","volume":"16","author":"Ogasawara","year":"2022","journal-title":"Case Rep. Gastroenterol."},{"key":"ref_26","first-page":"3862","article-title":"Small bowel perforation with multiple intestinal metastases from lung carcinoma: A case report","volume":"17","author":"Misiakos","year":"2019","journal-title":"Oncol. Lett."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1186\/s12957-019-1691-8","article-title":"An extremely rare primary sarcoma of the lung with peritoneal and small bowel metastases: A case report","volume":"17","author":"Librenjak","year":"2019","journal-title":"World J. Surg. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1159\/000529060","article-title":"Capsule Endoscopy-Based Diagnosis of Lung Squamous Cell Carcinoma Associated with Abdominal Pain and Metastasis to Small Intestine: A Case Report","volume":"16","author":"Zhong","year":"2023","journal-title":"Case Rep. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e7768","DOI":"10.1097\/MD.0000000000007768","article-title":"Metastatic spread of solid subtype lung adenocarcinoma to the small intestine with anemia and melena","volume":"96","author":"Ying","year":"2017","journal-title":"Medicine"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"109111","DOI":"10.1016\/j.ijscr.2023.109111","article-title":"Metastatic spread of primary lung adenocarcinoma to the small intestine: A case report","volume":"114","author":"Li","year":"2024","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e11027","DOI":"10.1097\/MD.0000000000011027","article-title":"Multiple gastrointestinal metastases of squamous-cell lung cancer","volume":"97","author":"Li","year":"2018","journal-title":"Medicine"},{"key":"ref_32","first-page":"rjx031","article-title":"Acute intestinal obstruction due to metastatic lung cancer\u2014Case report","volume":"2017","year":"2017","journal-title":"J. Surg. Case Rep."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/9\/904\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:33:31Z","timestamp":1760106811000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/9\/904"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,26]]},"references-count":32,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["diagnostics14090904"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14090904","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,26]]}}}