Intramural Duodenal Abscess Masquerading as Malignancy: Diagnosed and Managed by Endoscopic Ultrasound

Abstract Subepithelial lesions of the gastrointestinal tract are frequently encountered and are most often benign. Among the etiologies of subepithelial lesions, duodenal abscesses are exceptionally uncommon. Duodenal abscesses may have imaging characteristics that overlap with malignancy. A patient with history of necrotizing cholecystitis presented with abdominal pain 3 months after his cholecystectomy. Cross-sectional imaging revealed suspected duodenal malignancy. Endoscopic ultrasound identified a subepithelial lesion allowing for diagnosis and treatment of an intramural duodenal abscess. This case highlights an uncommon, delayed, postsurgical complication demonstrating the utility of endoscopic ultrasound in its diagnosis and management. Endoscopic ultrasound should be considered early in similar presentations.