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Table of Contents
CASE REPORT
Year : 2019  |  Volume : 8  |  Issue : 2  |  Page : 86-88

Acute abdomen as a clinical presentation of lymphoma: A case report


1 Medical Academic Center, Bangkok, Thailand
2 Adjunct professor, Joseph Ayobabalola University, Ikeji-arakeji, Nigeria

Date of Submission07-Jan-2019
Date of Decision21-Feb-2019
Date of Acceptance01-Mar-2019
Date of Web Publication20-Mar-2019

Correspondence Address:
Beuy Joob
Medical Academic Center, Bangkok
Thailand
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2221-6189.254435

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  Abstract 


Rationale: Acute abdomen is a medical emergency that requires prompt diagnosis and management. Lymphoma is a rare cause of acute abdomen. Patient concerns: A 54 year old patient complained of repeated episodes of acute abdominal pain over the past 3 months. Diagnosis: Mantle cell lymphoma. Interventions: Chemotherapy and stem cell transplantation. Outcomes: Abdomen pain disappeared and the patient was discharged uneventfully. Lessons: Although it is a rare cause of acute abdomen, lymphoma should be included in the differential diagnosis workup of patients with unexplained and unusual acute abdomen.

Keywords: Lymphoma, Acute, Abdomen, Presentation


How to cite this article:
Joob B, Wiwanitkit V. Acute abdomen as a clinical presentation of lymphoma: A case report. J Acute Dis 2019;8:86-8

How to cite this URL:
Joob B, Wiwanitkit V. Acute abdomen as a clinical presentation of lymphoma: A case report. J Acute Dis [serial online] 2019 [cited 2022 Oct 5];8:86-8. Available from: https://www.jadweb.org/text.asp?2019/8/2/86/254435




  1. Introduction Top


Acute abdomen is an important complaint in medical practice. It means the acute problem occurring at the abdominal part of patients, especially for acute pain. In general practice, acute abdomen is an important clinical presentation that requires good clinical diagnosis and management. There are several etiologies of acute abdomen. Lymphoma is a possible but rare cause of acute abdomen. Good history taking and physical examination both are important for diagnosis of acute abdomen. Basically, to obtain the history patients should give history on time without any interruption[1]. Then a gentle good physical examination should be done[1]. The importance of the good diagnosis is to reach the decision for management of the patient. Sometimes, the surgical management is needed and this is usually after the good diagnosis of acute abdomen[1].

Nevertheless, the unusual causes of acute abdomen are also possible and this situation might be easily misdiagnosed. Sometimes, acute abdomen might be the clinical presentation of malignancy[2]. The intraabdominal pathology due to malignancy can be the underlying cause of acute abdomen. Among several kind of malignancy, lymphoma is an interesting possible cause. In this brief clinical review, the authors reported and discussed on the acute abdomen as clinical presentation of lymphoma, an important hematological malignancy.


  2. Case report Top


This report was approved by etical committee of the medical center(MedAcad C08-2018). A 54 years old male patient presented to the physician with chief complaint of acute abdominal pain. This case gave the history of repeated episode of acute abdominal pain within the past 3 months. The physical examination showed soft abdomen without tenderness or guarding. The patient gave no history of diarrhea or abnormal stool passing. Then additional clinical work up in the patient was performed. X ray acute abdomen series showed no significant finding; the complete blood count, blood glucose, liver function test, renal function test and stool examination results were normal. To get the definitive diagnosis, abdominal CT scan was finally done and the enlarged lymph nodes within abdominal cavities could be detected. The positive CT finding was multiple enlarged round lymph nodes with uniform density and clear margin in abdominal cavity. Finally, the surgical approach was done for lymph node biopsy and the final clinical diagnosis of mantle cell lymphoma was derived. The patient was treated with chemotherapy and stem cell transplantation treatment.


  3. Discussion Top


3.1. Lymphoma as a cause of acute abdomen

Lymphoma is a common hematological malignancy that is observable worldwide, and is the malignant change of lymphoid cells in lymphoid organs. Lymphoma can exists at several organs including gastrointestinal organs. Hence, it is no doubt that there might be gastrointestinal symptoms in cases of gastrointestinal lymphomas. Acute abdomen is a possible clinical manifestation of gastrointestinal lymphoma. The rooted cause of the acute abdomen problem might be due to several pathophysiological process such as ischemia[3] and intussusception[4],[5],[6]. Regarding infarction, the direct vascular involvement combing with thrombotic event induced by lymphoma is the main pathogenesis[3]. Focusing on intussusception, lymphoma lesion might be the starting point for intussusception development[4]. The mentioned lymphoma lesion usually occurs at the small intestine area[4]. This problem is rare but is well documented. In pediatrics, there is a well-known condition namely “Norwich paediatric triad” that consists of malrotation, intussusception and small intestinal lymphoma[7].

Finally, HIV patients might have increased risk for lymphoma development, and HIV infected patients might have abdominal lymphoma and firstly presented with acute abdomen complaint[4],[8].

3.2. Types of lymphoma that can cause acute abdomen

Several types of lymphoma can cause acute abdomen problem. Non-Hodgkin’s lymphoma is the main group of lymphoma that might be associate with acute abdomen problem, and Burkitt’s lymphoma can result in intussusception and acute abdomen problem as well[4],[9]. The problematic lesion usually occurs at ileocecal area and easily mimics the acute appendicitis[9],[10],[11],[12],[13]. The primary B cell lymphoma can also occur at appendix and it can result in the clinical problem as a case of perforated appendicitis[14],[15]. Similarly, mantle cell lymphoma can also present as an acute appendicitislike clinical manifestation[16]. In the case with intestinal perforation, peritonism usually occurs and leads to acute abdomen problem. It should also note that the primary organs causing peritonism might not only include gastronintestinal tract but also genital tract organs. In females, lymphoma of ovary might invade adjacent colon and result in perforation that further result in acute abdomen problem[17]. In case with peritonism, CT scan investigation can show pneumoperitoneum and free intraperitoneal fluid[18].


  4. Conclusion Top


Lymphoma can cause acute abdomen problem. Although it is a rare cause of acute abdomen, lymphoma still should be included in the differential diagnosis list of unexplained and unusual patients presenting with acute abdomen.

Conflict of interest statement

The authors report no conflict of interest.



 
  References Top

1.
Hecker A, Hecker B, Kipfmüller K, Holler J, Schneck E, Reichert M, et al. Diagnosis and therapy of an acute abdomen. Med Klin Intensivmed Notfmed 2014; 109(6): 445-456.  Back to cited text no. 1
    
2.
Rice RP. Radiologic evaluation of the acute abdomen. CRC Crit Rev Clin Radiol Nucl Med 1973; 4(4): 555-597.  Back to cited text no. 2
    
3.
Kröber SM. Intravascular lymphoma causing acute abdomen. Pathologe 2007; 28(1): 51-54.  Back to cited text no. 3
    
4.
Sharma P, Balasingham S, Stawiarski K, Rahmani M, Costantino A, Sharma P, et al. Burkitt lymphoma as a lead point for jejunojejunal intussusception in a human immunodeficiency virus patient. Clin J Gastroenterol 2017; 10(4): 342-350.  Back to cited text no. 4
    
5.
Foley RW, Aworanti OM, Gorman L, McGovern B, O’Sullivan M, Smith OP, et al. Unusual childhood presentations of abdominal non-Hodgkin’s lymphoma. Pediatr Int 2016; 58(4): 304-307.  Back to cited text no. 5
    
6.
Stohlner V, Chatzizacharias NA, Parthasarathy M, Groot-Wassink T. Jejunojejunal intussusception as the initial presentation of non-Hodgkin’s B-cell lymphoma in an adult patient: A case report and review of the literature. Case Rep Surg 2013; 2013: 619031.  Back to cited text no. 6
    
7.
Sinha CK, Basson S, Patel RV, Mathur AB. Norwich paediatric triad: malrotation, intussusception and small intestinal lymphoma. BMJ Case Rep 2014; 2014: pii: bcr2013201110.  Back to cited text no. 7
    
8.
Wetter A, Schaudt A, Lehnert T, Schmidt-Matthiesen A, Jacobi V, Vogl TJ. Small-bowel intussusception as a rare differential diagnosis in HIV-positive patients with acute abdominal pain. Eur Radiol 2006; 16(4): 952-953.  Back to cited text no. 8
    
9.
Hoxha FT, Hashani SI, Krasniqi AS, Kurshumliu FI, Komoni DS, Hasimja SM, Maxhuni M. Intussusceptions as acute abdomen caused by Burkitt lymphoma: a case report. Cases J 2009; 2: 9322.  Back to cited text no. 9
    
10.
de Morais SD Jr, Mikhael BM, Németh SIA, Paulo IML, de Barros ÉOH, Lima OAT. Burkitt’s lymphoma presenting as acute appendicitis: a case report. J Surg Case Rep 2018; 2018(6): rjy131.  Back to cited text no. 10
    
11.
Sangma MM, Dasiah SD, Ashok AJ. Ileo-Colic Burkitt lymphoma in a young adult female-A case report. J Clin Diagn Res 2016; 10(4): PD11-2.  Back to cited text no. 11
    
12.
Klos D, Halama J, Chudácek J, Neoral C. Burkitt’s lymphoma of the caecum as a rare cause of acute abdomen: a case report. Rozhl Chir 2012; 91(2): 90-92.  Back to cited text no. 12
    
13.
Ghosal A, Acharyya S. A rare presentation of Hodgkin’s lymphoma in a very young child, with involvement of the appendix. BMJ Case Rep 2014; 2014: pii: bcr2014204027  Back to cited text no. 13
    
14.
Fu TY, Wang JS, Tseng HH. Primary appendiceal lymphoma presenting as perforated acute appendicitis. J Chin Med Assoc 2004; 67(12): 629-632.  Back to cited text no. 14
    
15.
Veenstra M, van Unen JM, Strobbe LJ. Acute abdomen as the first presentation of a malignant lymphoma of the small intestine. Acta Chir Belg 2014; 114(3): 209-211.  Back to cited text no. 15
    
16.
Chae M, Kumar S, Cheema M. Mantle cell lymphoma presenting as acute appendicitis. Int J Surg Case Rep 2015; 6C: 33-35.  Back to cited text no. 16
    
17.
Pandey S, Devanand B, John BJ, Singh G, Sivanandam S, Leelakrishnan V. High-grade non-Hodgkin’s lymphoma of ovary presenting as peritonitis. J Cancer Res Ther 2015; 11(3): 663.  Back to cited text no. 17
    
18.
Tamm EP, Fishman EK. CT appearance of acute abdomen as initial presentation in lymphoma of the large and small bowel. Clin Imaging 1996; 20(1): 21-25.  Back to cited text no. 18
    




 

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  In this article
Abstract
1. Introduction
2. Case report
3. Discussion
4. Conclusion
References

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