AB128. SOH21AS018. An unusual case of gastrointestinal bleeding and small bowel obstruction

Background: Gastrointestinal bleeding and small bowel obstruction are general surgical complaints frequently managed in the acute setting. They may rarely present together. Jejunal lymphoma is a potential, though infrequent, cause for such symptoms and has management implications that differ significantly from more commonly encountered causes. Lymphoma is the most common malignancy of the small bowel and accounts for 15–20% of all small intestinal neoplasms. They may mimic inflammatory bowel disease and should be included in differential diagnoses.

Methods: Case information: a 60-year old male presented to our centre with a 2-day history of epigastric pain, haematemesis and large-volume PR bleeding. His background included enteropathy-associated lymphoma on a background of Coeliac disease treated with jejunal resection and primary anastomosis. Computed tomography of abdomen was performed after admission, demonstrating a new area of jejunal lymphoma, likely recurrence at the previous resection site and porta hepatis invasion by an il-defined mass lesion. His bowel obstruction and gastrointestinal bleed were considered for palliative chemotherapy, though the patient unfortunately subsequently passed away.

Conclusions: Learning objectives: lymphoma is the most common malignancy of the small bowel and accounts for 15–20% of all small intestinal neoplasms. Jejunal lymphomas account for the minority of these lesions. They are nearly always B-cell non-Hodgkin’s lymphomas. This case represents an unusual presentation of porta hepatis invasion and small bowel obstruction. In the context of disseminated recurrent disease such as this, the prognosis is poor and management is principally symptom control.

Keywords: Emergency surgery; gastrointestinal bleeding; jejunal lymphoma; porta hepatis; small bowel obstruction