S2887 Diffuse Large B-Cell Lymphoma Presenting as Jejunal Diverticulitis on Imaging

Abstract

INTRODUCTION: Small bowel tumors comprise of only 5% of all neoplasms in the gastrointestinal tract. The diagnosis of small bowel tumors is often difficult due to the rarity of these lesions and the non-specific and variable presenting signs and symptoms. This can lead to a delay in diagnosis and poor treatment outcome. Frequently, small bowel tumors are diagnosed on imaging and confirmed by endoscopy. We describe a case of jejunal diffuse large B-cell lymphoma which was initially read as jejunal diverticulitis on imaging. CASE DESCRIPTION/METHODS: Our patient is a 60-year-old male with poorly controlled diabetes, hypertension, hyperlipidemia, and COPD who presented with abdominal pain, nausea, and vomiting. Abdominal pain was dull in nature, located around the umbilical area, and had been going on for about a month. He had made multiple emergency department visits for similar symptoms in the prior weeks. Also, he lost about 20 pounds of weight and had decreased appetite over the last 3 months. CT scan of the abdomen showed inflammatory changes surrounding the proximal jejunum (Image 1) characterized as jejunal diverticulitis. He was given antibiotics without any improvement in symptoms. Eventually, a push enteroscopy was performed which showed a partially obstructing mass just distal to the duodenojejunal junction (Image 2). Tattoos were placed proximally and distally for marking. Biopsy was diagnostic of diffuse large B-cell lymphoma. PET scan was performed which showed localized disease with adjacent lymph node involvement. Patient underwent surgical resection of the tumor due to concern of bowel perforation followed by chemotherapy. DISCUSSION: Tumors in the small bowel are exceedingly rare and can easily be overlooked as their presenting symptoms are bizarre and non-specific. The most common symptoms are pain, obstruction, and bleeding while perforation can rarely occur as well. Abdominal imaging is usually the first line modality to figure out the etiology of these symptoms. Imaging usually shows some abnormalities in these cases but is not confirmatory and at times may lead to other diagnoses as was the case in our patient. Patient’s history should be considered when figuring out the diagnosis in these cases. If there are any alarming symptoms such as weight loss, decreased appetite, or no improvement after initial treatment then there should be a high index of suspicion for small bowel tumors and endoscopy should be performed as early detection is the most important prognostic factor in these cases.Figure 1.: Inflammatory changes around the jejunal area read as jejunal diverticulitis.Figure 2.: Partially obstructing mass seen on enteroscopy distal to duodenojejunal junction.