An Elusive Source of Hematochezia: Ileal Neuroendocrine Tumor Diagnosed by Capsule and Balloon Enteroscopy

Small bowel neuroendocrine tumors (NETs) are uncommon and typically present with nonspecific symptoms, making diagnosis challenging. We report a 56-year-old man who presented with recurrent hematochezia and severe anemia. Extensive evaluation with esophagogastroduodenoscopy, colonoscopy, computed tomography angiography, and tagged red blood cell scan were nondiagnostic. Video capsule endoscopy identified distal small bowel bleeding, localized by retrograde balloon-assisted enteroscopy. Biopsy revealed a well-differentiated NET, and surgical resection confirmed a localized grade 2 ileal NET. This case highlights the importance of considering small bowel NETs in obscure gastrointestinal bleeding and demonstrates the complementary diagnostic role of video capsule endoscopy and balloon-assisted enteroscopy.