Synchronous Aspirin-Induced Ileal Ulcer and Ascending Colon Adenocarcinoma: Diagnostic Challenges and Pathophysiological Insights from an Incidental Intraoperative Finding

Zejin Zhao¹Yue Xiao¹Hui Zhao²Jian Li¹Jinlong Liu^1*

• ¹Affiliated Hospital of Chengde Medical University, Chengde, China
• ²Tangshan People's Hospital, Tangshan, China

Synchronous gastrointestinal lesions are rare, especially when colon cancer is complicated by non-specific ileal ulcers. This article reports the case of a 70-year-old man who was admitted to the hospital with a colonic space-occupying lesion detected on physical examination, and an unexpected intraoperative finding of a synchronous ileal lesion with suspected malignant signs. The patient had no history of inflammatory bowel disease and was on regular low-dose aspirin (100 mg/d) for a long time. Colonoscopy showed a mass in the ascending colon and biopsy confirmed the diagnosis of moderately differentiated carcinoma. In addition to the ascending colon tumour, an ulcer with focal necrosis and enlarged lymph nodes was seen in the ileum about 40 cm from the Bauhin valve, which was suspected to be malignant or heterogeneous. To ensure complete resection of the lesion, a partial resection of the right hemicolon combined with ileum was performed, and the bowel was reconstructed using a single anastomosis technique. The right upper colon and terminal ileum were resected as a whole, measuring approximately 60 cm in length. Postoperative pathology confirmed the diagnosis of adenocarcinoma of the colon (pT3N0M0) and non-specific ulceration of the ileum, and ruled out Crohn's disease, infection, and other etiologies. The combination of the patient's medication history and the absence of evidence of metastasis suggests that aspirin-associated mucosal injury and tumour distant pro-inflammatory mechanisms may be synergistically pathogenic. Postoperative recovery was good with no complications. This case emphasises the importance of comprehensive intraoperative exploration, highlights the key role of multidisciplinary collaboration in differential diagnosis and surgical decision-making, and provides lessons for individualised management of synchronous gastrointestinal lesions.