We describe a patient who presented with iron deficiency anaemia in whom both upper and lower gastrointestinal investigation were initially negative. Management included successive blood transfusions. Repeat investigation six months later revealed caecal adenocarcinoma. At laparotomy, the patient was also found to have two separate primary synchronous adenocarcinomas of the proximal small bowel. Right hemicolectomy and excision of the small bowel lesions were carried out. The patient eventually succumbed to the disease six weeks after discharge from hospital.