Perforated small bowel lymphoma presenting as an acute abdomen and requiring emergency surgery, a case report

Abstract

Abstract Introduction: Diffuse large B cell lymphoma (DLBCL) is the most common type of non-Hodgkin’s lymphoma (NHL). It accounts for most lymphomas affecting the gastrointestinal (GI) tract. Extranodal sites include the stomach, small intestine, and ileocecal region. Mesentery is commonly involved. Symptoms are generally non-specific but may present as surgical emergencies secondary to perforation or ischemia. Case presentation: This case report discusses an emergency presentation of a DLBCL in a 74-year-old male. On examination, he had a palpable mass in the mid abdomen. Cross sectional computed tomography (CT) demonstrated a large intra-peritoneal mass, 20cm in transverse diameter with a smaller more proximal mass. Prior to treatment initiation he represented with an acute abdomen. He underwent an emergency laparotomy. Encasement of the SMA (Superior mesenteric artery) produced ischemia and subsequent perforation of a segment of distal small bowel. This required resection and formation of an end ileostomy. The 20cm mass involving the proximal mesentery was left in situ as safe surgical removal was not feasible. Conclusion: We conclude that in the case of mesenteric lymphoma, surgical intervention should address the compromised bowel segment and accompanying contamination only to avoid vascular risks or potential for extensive small bowel resection. When stabilized the definitive treatment should be in the form of systemic chemotherapy.