Tubulo-villous tumours of the duodenum are rare tumours which account for less than 1% of duodenal neoplasms, 88% of which are located in the second part of duodenum. The remaining 12% are equally distributed in first and third part of the duodenum [1, 2]. A high rate of malignant transformation complicates management with surgical treatment options ranging from wide local excision to radical pancreaticoduodenectomy [1]. A case of duodenal villous adenoma of the first part of duodenum presenting with vague generalized abdominal pain, nausea and weight loss is reported because of its rarity.