Atypical presentation of small bowel lymphoma as surgical emergency

Abstract

Gastrointestinal tract is the most frequent site of extranodal involvement by non-Hodgkin's lymphoma, though extranodal lymphoma may arise anywhere outside lymph nodes, stomach is the most commonly involved organ followed by the small intestine, pharynx, colon, and rarely, esophagus. 26 year old male with history of pain abdomen for 3 days, involving whole abdomen, associated with bilious vomiting, non passage of flatus and stools for 2 days. Patient also had multiple spikes of high grade fever associated with chills and rigors for 2 days. Abdominal examination revealed features of peritonitis. CXR revealed free gas under diaphragm. Patient planned for emergency exploratory laparotomy. Intraoperatively stricture perforation proximal to ileocaecal junction noted. Resection of stricture segment with ileo-ascending anastomosis performed. Biopsy revealed Diffuse large B cell lymphoma. 52 year male with history of central abdominal distension for 4 days with multiple episodes of bilious vomiting and non passage of flatus and stools for 2 days. Abdominal examination revealed marked abdominal distension with generalised tenderness and exaggerated bowel sounds. Abdomen X Ray revealed multiple air fluid levels. Intraoperatively growth of 8×5 cm present 10 cms proximal to ileocaecal junction. Resection of diseased segment with ileoascending anastomosis performed. Biopsy of resected segment revealed Diffuse large B cell lymphoma. Patient started on R-CHOP regimen, doing well. Here we present two cases of Diffuse large B cell lymphoma showing bimodal presentation with rare clinical presentation, one as a perforation and other as obstruction.