# Chemotherapy-Naïve Jejunal Lymphoma Fistulising With the Urinary Bladder

## TL;DR

A rare case of jejunal lymphoma fistulizing into the bladder was misdiagnosed as Crohn's disease before surgery revealed the true condition.

## Contribution

Highlights the rarity and diagnostic difficulty of jejunal lymphoma fistulizing into the bladder without prior chemotherapy.

## Key findings

- Jejunal lymphoma fistulizing into the bladder is extremely rare and often misdiagnosed.
- Perforation and fistulization occurred in a chemotherapy-naïve patient.
- Histopathology confirmed the diagnosis after surgical resection.

## Abstract

An elderly male was diagnosed with Crohn’s disease empirically elsewhere and put on mesalamine tablets. A few months later, he developed acute dysuria and bile-stained urine. Computerized tomography revealed a contained jejunal perforation with a phlegmonous collection eroding into the dome of the urinary bladder with multiple intact tablets within it. At laparotomy, the affected segment of the jejunum and dome of the bladder were resected en bloc and intact mesalamine tablets were retrieved. Appropriate reconstruction was done. Histopathology examination confirmed it to be diffuse large B-cell lymphoma. Primary jejunal lymphoma is a rare occurrence with non-specific clinical presentation, posing diagnostic challenges. Perforation of chemotherapy-naïve lymphoma is uncommon and fistulizing into the bladder is even rarer.