A rare case of diffuse large B cell lymphoma presenting as jejunal perforation

Abstract

Diffuse large B-cell lymphoma can present as either primary lymph nodal disease or with involvement of extra-nodal sites. In gastrointestinal involvement, the clinical presentation is often insidious, such as abdominal pain, nausea, vomiting, anemia, weight loss, fever, and occasionally small bowel obstruction or a palpable mass. Small-bowel perforation as the first manifestation of non-Hodgkin’s lymphoma is extremely rare. The case of a 73-year-old woman is reported who presented to the emergency department complaining of a generalized abdominal pain and vomiting. Contrast enhanced computer tomogram (CECT) of the abdomen showed multiple air pockets in left side of abdomen, right hemidiaphragm, edematous small bowel loops with fat stranding with multiple tiny air pockets. Laparotomy was performed that revealed a focally perforated segment of the jejunum. Histological evaluation reported diffuse large B-cell non-Hodgkin’s lymphoma. This case illustrates a rare complication of large B-cell non-Hodgkin’s lymphoma of the jejunum that was responsible for small-bowel perforation and peritonitis. This clinical pattern may appear as a leading presentation of small intestinal neoplastic disease in which surgical resection may have to be considered.