Primary small gut lymphoma presenting as an incarcerated inguinal hernia in an adult

Abstract

A 73-year-male presented with features of subacute small gut obstruction of 10 days duration. He also complained of a painless, slowly enlarging swelling in the right groin, which was first noticed 10 years ago. There was a history of weight loss, anorexia, and asthenia but no history of fever, respiratory, or urinary symptoms. He was a smoker and was on medication for hypertension and type 2 diabetes mellitus. The general health of the patient was poor. He appeared pale and dehydrated. No lymphadenopathy was evident on the general survey. The abdomen was distended, tense with hyperactive bowel sounds. Examination of the groin and genitalia revealed right inguinal hernia and an irreducible, firm, solid, nontender, 6 cm × 5 cm scrotal mass separate from the right testis. Digital rectal examination revealed no abnormality. Contrast-enhanced computed tomography of the abdomen showed dilated gut loops, right inguinal hernia, and a gut related endophytic soft-tissue mass in the scrotum. Exploration after resuscitation revealed a firm, endoluminal soft-tissue mass arising from the apex of the herniated loop of the small gut which was obliterating its lumen. The tumor-bearing segment of the gut was resected through a groin incision. We then performed a laparotomy to bring out the ends of the bowel loops as double barrel ileostomy. The hernial defect was then repaired. Postoperative recovery was uneventful. Histopathology of the excised specimen suggested the possibility of Non-Hodgkin's lymphoma of small gut. Immunohistochemistry confirmed it to be low-grade follicular B-cell NHL.