A 55-year-old woman presented with symptoms of progressive sub-acute high gastrointestinal obstruction. Barium studies, upper gastrointestinal endoscopy, ultrasound and ERCP were normal. Diagnosis was therefore delayed. At laparotomy, malignant tumours were found at the duodenojejunal flexure and left ovary, which were histologically identical and consistent with an ovarian primary. Endoscopic techniques for visualization of the third and fourth parts of the duodenum should be employed after barium studies, including careful screening in this area, have failed to reveal pathology.
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