Asian Journal of Case Reports in Surgery

Aims: This report aims to highlight the diagnostic challenges posed by pseudo-tumoral lesions mimicking malignancy in elderly patients presenting with small bowel obstruction (SBO), and to emphasize the importance of histopathological confirmation in guiding appropriate management.

Presentation of Case: An 85-year-old woman with no history of prior abdominal surgery presented with epigastric pain, vomiting, and signs of intestinal obstruction. Laboratory findings showed elevated inflammatory markers. Imaging suggested SBO due to adhesions. However, clinical deterioration with hypotension prompted urgent exploratory laparotomy, revealing a 3 × 4 cm small bowel mass and a 1 × 2 cm mesenteric lymph node. An oncologic resection with manual end-to-end anastomosis was performed. Surprisingly, histopathology showed nonspecific inflammatory thickening with no evidence of malignancy.

Discussion: While SBO in elderly patients commonly results from adhesions or neoplasms, inflammatory pseudo-tumoral lesions can mimic malignancy both clinically and radiologically. These lesions may stem from chronic inflammation or infection, and are indistinguishable from true neoplasms on imaging. In such cases, intraoperative findings often necessitate resection to exclude malignancy, as preoperative differentiation remains limited.

Conclusion: Pseudo-tumoral inflammatory lesions are rare but important differential diagnoses in SBO. Surgical exploration and histopathological analysis are essential for accurate diagnosis. Awareness of these entities can prevent unnecessary oncologic treatment, particularly in elderly patients with nonspecific presentations.