<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2341-4545</journal-id>
<journal-title><![CDATA[GE-Portuguese Journal of Gastroenterology]]></journal-title>
<abbrev-journal-title><![CDATA[GE Port J Gastroenterol]]></abbrev-journal-title>
<issn>2341-4545</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Gastrenterologia]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2341-45452023000200059</article-id>
<article-id pub-id-type="doi">10.1159/000520906</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Small Bowel Adenocarcinoma in a Patient with Crohn&#8217;s Disease: The Role of Balloon-Assisted Enteroscopy]]></article-title>
<article-title xml:lang="pt"><![CDATA[Adenocarcinoma do intestino delgado num doente com doença de Crohn: o papel da enteroscopia assistida por balão]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Dias]]></surname>
<given-names><![CDATA[Emanuel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Saraiva]]></surname>
<given-names><![CDATA[Miguel Mascarenhas]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Moreira]]></surname>
<given-names><![CDATA[Francisco]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cardoso]]></surname>
<given-names><![CDATA[Hélder]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Macedo]]></surname>
<given-names><![CDATA[Guilherme]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Centro Hospitalar de São João Gastroenterology Department ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Centro Hospitalar de São João Pathology Department ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>04</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>04</month>
<year>2023</year>
</pub-date>
<volume>30</volume>
<numero>2</numero>
<fpage>59</fpage>
<lpage>64</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2341-45452023000200059&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2341-45452023000200059&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2341-45452023000200059&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction:  Small bowel adenocarcinoma is a rare but well-known complication of Crohn&#8217;s disease. Diagnosis can be challenging, as clinical presentation may mimic an exacerbation of Crohn&#8217;s disease and imaging findings may be indistinguishable from benign strictures. The result is that the majority of cases are diagnosed at the time of operation or postoperatively at an advanced stage.  Case Presentation:  A 48-year-old male with a previous 20-year history of ileal stenosing Crohn&#8217;s disease presented with iron deficiency anemia. The patient reported melena approximately 1 month earlier but was currently asymptomatic. There were no other laboratory abnormalities. Anemia was refractory to intravenous iron replacement. The patient underwent computerized tomography enterography, which revealed multiple ileal strictures with features suggesting underlying inflammation and an area of sacculation with circumferential thickening of adjacent bowel loops. Therefore, the patient underwent retrograde balloon-assisted small bowel enteroscopy, where an area of irregular mucosa and ulceration was found at the region of ileoileal anastomosis. Biopsies were performed and histopathological examination revealed tubular adenocarcinoma infiltrating the muscularis mucosae. The patient underwent right hemicolectomy plus segmental enterectomy of the anastomotic region where the neoplasia was located. After 2 months, he is asymptomatic and there is no evidence of recurrence.  Discussion:  This case demonstrates that small bowel adenocarcinoma may have a subtle clinical presentation and that computed tomography enterography may not be accurate enough to distinguish benign from malignant strictures. Clinicians must, therefore, maintain a high index of suspicion for this complication in patients with long-standing small bowel Crohn&#8217;s disease. In this setting, balloon-assisted enteroscopy may be a useful tool when there is raised concern for malignancy, and it is expected that its more widespread use could contribute to an earlier diagnosis of this severe complication.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução:  O adenocarcinoma do intestino delgado é uma complicação rara mas bem estabelecida da doença de Crohn. O seu diagnóstico pode ser desafiante, na medida em que a apresentação clínica pode mimetizar uma agudização da doença de Crohn e os achados ima-giológicos podem ser indistinguíveis de estenoses benignas. Em consequência, a maioria dos casos são diagnosticados durante ou após a cirurgia em estadio avançado.  Descrição do caso:  Um homem de 48 anos com antecedentes de doença de Crohn ileal estenosante, com 20 anos de evolução, apresentou-se com anemia ferropénica. O doente referia melenas aproximadamente um mês antes, mas encontrava-se atualmente assintomático. Não apresentava outras alterações laboratoriais de relevo. A anemia era refratária a suplementação com ferro endovenoso. Foi submetido a enterografia por tomografia computorizada, que revelou múltiplas estenoses ileais com caraterísticas sugestivas de atividade inflamatória e uma área de saculação com espessamento circunferencial das ansas de intestino delgado adjacentes. Assim, foi submetido a enteroscopia assistida por balão, onde se identificou uma área de mucosa irregular e ulceração na região da anastomose ileo-ileal. Biópsias desta área revelaram a presença de adenocarcinoma tubular com infiltração até à muscularis mucosae. O doente foi submetido a hemicolectomia direita com enterectomia segmentar da região da anastomose onde a neoplasia se encontrava localizada. Ao fim de 2 meses, o doente encontra-se assintomático e sem evidência de recorrência.  Discussão:  Este caso demonstra que o adenocarcinoma do intestino delga-do pode ter uma apresentação clínica subtil e que a enterografia por tomografia computorizada pode não ter precisão suficiente para distinguir estenoses benignas de neoplasias malignas. Os clínicos devem, portanto, manter um elevado índice de suspeição diagnóstica para esta complicação em doentes com doença de Crohn ileal de longa duração. Neste contexto, a enteroscopia assistida por balão pode ser uma ferramenta útil em casos de suspeita de neoplasia maligna, esperando-se que possa contribuir para um diagnóstico mais precoce desta complicação severa.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Crohn&#8217;s disease]]></kwd>
<kwd lng="en"><![CDATA[Inflammatory bowel disease]]></kwd>
<kwd lng="en"><![CDATA[Small bowel adenocarcinoma]]></kwd>
<kwd lng="en"><![CDATA[Enteroscopy]]></kwd>
<kwd lng="pt"><![CDATA[Doença de Crohn]]></kwd>
<kwd lng="pt"><![CDATA[Doença inflamatória intestinal]]></kwd>
<kwd lng="pt"><![CDATA[Adenocarcinoma do intestino delgado]]></kwd>
<kwd lng="pt"><![CDATA[Enteroscopia]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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