An Unusual Duodenal Subepithelial Lesion: A Challenging Case

The diagnostic journey in gastrointestinal lesions, particularly when presenting with atypical features, often poses formidable challenges in clinical practice. This challenge is vividly illustrated in the case of an 88-year-old man with severe acute-on-chronic gangrenous cholecystitis. Imaging studies prior to surgery unveiled an unexpected 30 × 26 mm nodular formation nestled between the pancreas and duodenum suspected for neoplasia. Endoscopic ultrasound allows obtaining an atypical benign diagnosis of a benign subepithelial lesion. This intriguing case highlights the intricate nature of differential diagnosis in such lesions, especially when they attain substantial dimensions. The nuanced imaging features and integration of advanced techniques like endoscopic ultrasound with DWI and elastography emerge as pivotal tools in achieving precise diagnosis and guiding tailored treatment strategies.