AB147. SOH22ABS102. Primary diffuse large B-cell lymphoma of the small bowel in the emergency surgical setting
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AB147. SOH22ABS102. Primary diffuse large B-cell lymphoma of the small bowel in the emergency surgical setting

Jason Mahony Mahony, Shane Keogh, Amro Osman, Markus Kostka, Seamus Murphy

Department of Surgery, University Hospital Waterford, Waterford, Ireland

Background: The gastrointestinal tract is a frequent site of extra-nodal non-Hodgkin’s lymphoma (NHL) however primary small bowel NHL are rare. Diagnosis is typically delayed due to the lack of specific symptoms and many present in the emergency surgery setting. Management and prognosis differ from adenocarcinomas therefore it is important for surgeons to be aware of this rare diagnosis.

Case Description: We report the case of a 65-year-old male who presented to our institution with acute onset right iliac fossa pain. A CT AP identified a 7.5 cm segment of circumferential thickening in the distal ileum with multiple enlarged mesenteric and para-aortic lymph nodes with necrotic centres. An emergency laparoscopic assisted small bowel resection and primary anastomosis was performed. Histology revealed a tumour comprising sheets of large lymphoid cells with pleomorphic nuclei positive for CD20, bcl2, MUM1, consistent with diffuse large B-Cell lymphoma (DLBCL). Three of nine lymph nodes also contained tumour and the resections margins were free of tumour. The patient recovered with no complications and was discharged on post-operative day six. The patient was evaluated by haematology and initiated chemotherapy, rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone (R-CHOP).

Conclusions: DLBCL presenting as obstructing mass and resulting in small bowel obstruction is rare. Surgical management of small bowel NHL is limited to the emergency setting for complications. The lack of guidance for postoperative management following emergency presentations and timing of chemotherapy can complicate outcomes. Despite being less common than adenocarcinoma, lymphoma should always remain in the differential diagnosis of small bowel tumours and prompt referral to haematology for chemotherapy is needed.

Keywords: Delayed diagnosis; emergency surgical setting; obstruction; primary diffuse large B-cell lymphoma (primary DLBCL); small bowel

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-22-ab147
Cite this abstract as: Mahony JM, Keogh S, Osman A, Kostka M, Murphy S. AB147. SOH22ABS102. Primary diffuse large B-cell lymphoma of the small bowel in the emergency surgical setting. Mesentery Peritoneum 2022;6:AB147.

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