Photoclinic Diagnosis: Ileal Duplication Cyst

A54-year-old gentleman was referred to our gastrointestinal (GI) clinic. The chief complaint was a black tarry stool since two months prior to the admission. He was well up to two years ago, when he developed fatigue and weakness. He was managed with the impression of alpha-thalassemia during these two years. He had no abdominal pain, nausea and vomiting, weight loss, fever, constipation, or diarrhea during this period. He was a smoker and an opium user. Physical examination was unremarkable. Laboratory results were as follows: white blood cell count: 10×109/L hemoglobin: 7.4 g/dL, mean corpuscular volume: 66 fL, platelet count: 266109/L, prothrombin time:12.9 s, INR: 1.1, albumin: 4.1 g/dL, blood urea nitrogen: 12 mg/dL, creatinine: 0.8 mg/dL, sodium: 135 mEq/L, potassium: 4.1 mEq/L, calcium: 9.2 mg/dL, triglyceride: 127 mg/dL, cholesterol: 148 mg/dL, stool examination: unremarkable, serum iron: 15 μg/dL, and total iron-binding capacity: 500 μg/dL. Upper GI endoscopy and full colonoscopy were normal. Images from small bowel series (Figures 1 and 2) and double balloon enteroscopy (Figure 3), are shown above.