Small Bowel Intussusception Due to a Primary Non-Hodgkin's Lymphoma. An Unusual Presentation and Clinical Course
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Adult intussusception is a rare clinical entity accounting for 5% of all intussusceptions. Symptoms and signs are often vague and non-specific making a preoperative diagnosis difficult. The purpose of this study is to present a rare case of a jejuno-jejunal intussusception due to primary intestinal non-Hodgkin's lymphoma in a patient with an unusual clinical course.
A 78-year-old man presented with a 1-month history of abdominal pain, nausea, epigastric fullness, and weight loss. Computed tomography scan and ultrasonography findings were suggestive of small bowel intussusception.
Laparotomy revealed a jejuno-jejunal intussusception caused by a primary B cell non-Hodgkin's lymphoma 20 cm distal to the ligament of Treitz. Resection without prior reduction was performed. The patient refused postoperative adjuvant chemotherapy. Seven months later, he presented with upper gastrointestinal bleeding, and the diagnostic evaluation revealed gastric infiltration of large B cell non-Hodgkin's lymphoma. Despite chemotherapy, he died of disseminated progressive disease 7 months later.
Adult jejuno-jejunal intussusception due to primary non-Hodgkin's lymphoma is a rare clinical entity. A high index of suspicion is needed as symptoms and signs are not pathognomonic. Appropriate investigations can lead to a prompt preoperative diagnosis. Resection without prior reduction is the treatment of choice. Our patient's refusal of postoperative adjuvant chemotherapy likely resulted in relapse of the disease in another part of the gastrointestinal tract.
Keywordsadult intussusception small bowel lymphoma primary
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Koch P, del Valle F, Berdel WE, Willich NA, Reers B, Hiddemann W, et al. Primary gastrointestinal non-Hodgkin's lymphoma: I. Anatomic and histologic distribution, clinical features, and survival data of 371 patients registered in the German Multicenter Study GIT NHL 01/92. German Multicenter Study Group. J Clin Oncol. 2001;19:3861–73.PubMedGoogle Scholar
- 3.Yin I, Chen CQ, Peng CH, Chen GM, Zhou HJ, Han BS, et al. Primary small-bowel non-Hodgkin’s lymphoma: a study of clinical features, pathology, management and prognosis. J Inter Med Res. 2007;35:406–15.Google Scholar
- 5.Scheri R, Drebin JA. Tumors of the small intestine. In: Cameron J, editor. Current surgical therapy. 9th ed. Philadelphia: Elsevier Mosby; 2004. p. 120–4.Google Scholar
- 8.Houghton JM, Wang TC. Tumors of the stomach. In: Feldman M, Friedman LS, Sleisenger MH, editors. Sleisenger and Fordtran's gastrointestinal and liver disease. 8th ed. Philadelphia: Saunders Elsevier; 2006. p. 1139–70.Google Scholar
- 13.d'Amore F, Brincker H, Grønbaek K, Thorling K, Pedersen M, Jensen MK, et al. Non-Hodgkin's lymphoma of the gastrointestinal tract: a population-based analysis of incidence, geographic distribution, clinicopathologic presentation features, and prognosis. Danish Lymphoma Study Group. J Clin Oncol. 1994;12:1673–84.PubMedGoogle Scholar