International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties. Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. ABSTRACT Introduction:

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... Primary duodenal adenocarcinoma is extremely rare. If this carcinoma occurs in fourth portion, it can now be diagnosed by recent developments in enteroscopy. Case Report: We report a rare case of primary duodenal adenocarcinoma of the fourth portion diagnosed by double-balloon enteroscopy and resected surgically. A 57-year-old male was anemic. Positron emission tomography -computed tomography revealed accumulation in the fourth portion of the duodenum. Double-balloon enteroscope showed circular tumor of the fourth portion of the duodenum, and biopsy disclosed poorly differentiated adenocarcinoma. Partial duodenectomy and partial colonectomy were performed. The marginal artery of the transverse colon was invaded. Histological examination disclosed that the tumor was poorly differentiated adenocarcinoma and two lymph node metastases were seen. Conclusion: Primary duodenal adenocarcinoma of fourth portion can be diagnosed by doubleballon enteroscopy and treated by surgical resection. AbstrAct Introduction: Primary duodenal adenocarcinoma is extremely rare. If this carcinoma occurs in fourth portion, it can now be diagnosed by recent developments in enteroscopy. case report: We report a rare case of primary duodenal adenocarcinoma of the fourth portion diagnosed by double-balloon enteroscopy and resected surgically. A 57-year-old male was anemic. Positron emission tomographycomputed tomography revealed accumulation in the fourth portion of the duodenum. Doubleballoon enteroscope showed circular tumor of the fourth portion of the duodenum, and biopsy disclosed poorly differentiated adenocarcinoma. Partial duodenectomy and partial colonectomy were performed. the marginal artery of the transverse colon was invaded. Histological examination disclosed that the tumor was poorly differentiated adenocarcinoma and two lymph node metastases were seen. conclusion: Primary