Case Summary
Case Title: Small Bowel Tumor
Final Diagnosis: Pseudotumor / Organized Abscess
Patient Profile
- Age/Sex: 50-year-old male
Clinical Presentation: - Vague abdominal pain following a recent febrile illness
- No history of weight loss or loss of appetite
Investigations
Blood Tests:
- All tumor markers – Negative
- Routine blood investigations – Normal
Imaging Findings:
- Ultrasound: Revealed a soft tissue lesion encasing the superior mesenteric vessels (SMA) and proximal portal vein.
- CECT Abdomen (Mesenteric Angiography): Showed a small bowel mass with adherent small bowel loops, involving the third part of the duodenum and encasing mesenteric vessels.
- Differential diagnoses considered: Gastrointestinal Stromal Tumor (GIST) or Neuroendocrine Tumor (NET)
Surgical Procedure
- Operation: Exploratory Laparotomy
- Position: Supine
Procedure Performed:
- Small bowel resection via open approach
- Careful dissection of the lesion from the third part of the duodenum
- Tumor successfully separated from the mesenteric vessels, which were preserved (as seen in the image)
Postoperative Course
- Anticoagulation: Administered for 7 days postoperatively
- Recovery: Uneventful; patient discharged on postoperative day 7 in stable condition
Histopathology Findings
- The resected lesion revealed a chronic organized abscess / pseudotumor.
- The findings suggest a possible unrecognized or undiagnosed small bowel perforation, which may have spontaneously contained and evolved into a localized abscess, eventually healing with fibrosis and scar formation—mimicking a neoplastic mass.
Take-Home Message
- Not all apparent tumors are malignant.
- A detailed clinical history and thorough evaluation often provide crucial diagnostic clues that guide appropriate management.
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