A case of small intestinal malignant lymphoma associated with intestinal obstruction: A case report

TL;DR

An elderly man with recurring intestinal blockages was found to have a rare type of intestinal lymphoma, highlighting the need to consider cancer in such cases.

Contribution

This case report emphasizes the importance of considering small intestinal lymphoma in elderly patients with recurrent bowel obstructions.

Findings

Small intestinal malignant lymphoma can present as bowel obstruction and should be considered in recurrent SBO cases.

CT findings like bowel wall thickening and lymphadenopathy can aid in diagnosing intestinal lymphoma.

Laparoscopic resection and histopathology confirmed diffuse large B-cell lymphoma in this patient.

Abstract

Small bowel obstruction (SBO) is a common surgical emergency, most frequently caused by postoperative adhesions. However, neoplastic etiologies, including malignant lymphoma, should also be considered in the differential diagnosis.

A 78-year-old Japanese man with a history of recurrent SBO since 2021 presented with nausea and abdominal distention. He had previously undergone conservative treatment on seven occasions. Contrast-enhanced computed tomography revealed small bowel dilatation with segmental wall thickening and enhanced contrast effect, along with enlarged mesenteric lymph nodes. He was diagnosed with SBO and admitted for emergency treatment. An ileus tube was inserted, and contrast study on day 3 revealed a stricture in the ileum, which the tube could not pass. Adhesive ileus and small intestinal tumor were both considered. As conservative treatment was ineffective, laparoscopic-assisted segmental ileal resection was performed. Histopathological examination revealed diffuse large B-cell lymphoma. Postoperative recovery was uneventful, and he was discharged on postoperative day 21. Positron emission tomography/computed tomography showed FDG uptake in mesenteric lymph nodes (SUVmax 3.7), consistent with Lugano stage II disease. Due to advanced age and dementia, the patient did not undergo chemotherapy. He remains under surgical follow-up without disease progression one year postoperatively.

This case highlights that repeated SBO may not always be caused by adhesions alone, and intestinal lymphoma should be considered, especially when imaging reveals suspicious findings.

In cases of recurrent SBO, small intestinal lymphoma should be included in the differential diagnosis, even in elderly patients with a history of abdominal surgery.

•Small intestinal malignant lymphoma presenting with bowel obstruction is rare.•Recurrent adhesive ileus may conceal an underlying small intestinal tumor.•CT findings such as bowel wall thickening and lymphadenopathy aid diagnosis.

Small intestinal malignant lymphoma presenting with bowel obstruction is rare.

Recurrent adhesive ileus may conceal an underlying small intestinal tumor.

CT findings such as bowel wall thickening and lymphadenopathy aid diagnosis.

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