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an extremely rare disease. We present a unique case in which endoscopic examination of the deep small bowel was necessary to make the diagnosis using spiral enteroscopy. An 82-year-old man with a history of radiation therapy for prostate cancer was referred for persistent, obscure-overt gastrointestinal bleeding. Recent upper endoscopy with push enteroscopy approximately 20 cm beyond the ligament of Treitz (LOT)was negative. Ileocolonoscopy only revealed blood in the terminal ileum. Computed tomography (CT) angiogram and bleeding scan were negative. The patient received a total of 29 units of packed red blood cells, 10 units of fresh frozen plasma, and 7 units of platelets in the month prior to presentation. On admission to our hospital, his hemoglobin level was 8 g/dL with a normal platelet count and prothrombin time. Anterograde (per os) spiral overtube-assisted enteroscopy was performed. The enteroscope was inserted approximately 230 cm beyond the LOT. Beginning at 40 cm past the LOT, there were innumerable exophytic, polypoid masses that were oozing blood ranging in size from 5mm to 30mm (●" Fig. 1). The lesions blanketed the entire jejunum. Multiple biopsies were obtained (●" Video 1). Histopathological examination revealed sheets of epithelioid cells with ample eosinophilic cytoplasm containing pleomorphic nuclei (●" Fig. 2, 3). Frequent mitoses and primitive vascular channels were identified. The diagnosis of angiosarcomawas confirmed by special stains for vimentin, CD31/34 and factor VIII-related antigen (●" Fig. 4). The patient died 6 weeks later from intractable bleeding and exsanguination. Primary jejunal angiosarcoma: an extremely rare tumor diagnosed by means of anterograde spiral enteroscopy