[The duodenojejunal flexure--a gap in the routine diagnosis of gastrointestinal bleeding].

History And Admission Findings: Because of tarry stools a 64-year-old woman had two years previously undergone oesophagogastroduodenoscopy (OGD), coloscopy and examination of the small intestine (according to Sellink) without significant findings. She was again hospitalized because of anemia (6.1 g/dl). Physical examination was unremarkable.

Investigations: After unremarkable OGD (as far as the descending part of the duodenum) and coloscopy, hypotonic duodenography revealed a tumor in the region of the duodenojejunal flexure.

Treatment And Course: The tumor, histologically a leiomyoma, was resected.

Conclusion: OGD, coloscopy and small intestinal radiography may fall to identify the source of bleeding because of a diagnostic gap in the region of the duodenojejunal flexure. In this case hypotonic duodenography should be performed, if enteroscopy is not available.