The patient underwent endoscopy confirming D3/D4 adenocarcinoma on biopsy. She underwent a duodenotomy and anastomosis and went on to receive adjuvant chemotherapy with a good response to treatment at one year. The patient had a history of celiac disease, which is a risk factor for small bowel adenocarcinoma, with the risk as high as 60-80x if a late diagnosis and poor adherence to a gluten-free diet.