J Korean Med Sci.  2016 Feb;31(2):321-325. 10.3346/jkms.2016.31.2.321.

Chronic Intussusception Caused by Diffuse Large B-Cell Lymphoma in a 6-Year-Old Girl Presenting with Abdominal Pain and Constipation for 2 Months

• Choi SH
• Han SA
• Won KY

• KMID: 2360060
• DOI: http://doi.org/10.3346/jkms.2016.31.2.321

Abstract

The classical triad of abdominal pain, vomiting, and bloody stool is absent in chronic intussusception for more than 2 weeks. Here, we report a 6-year-old female with recurrent abdominal pain for 2 months. Ultrasonography of the abdomen revealed an ileocolic-type intussusception. The lesion accompanying the tight fibrous adhesion was treated by resection and ileocolic anastomosis. It was diagnosed as intussusception with diffuse large B-cell lymphoma. A high index of suspicion for abdominal pain in children should result in the correct diagnosis and appropriate management.

Keyword

Intussusception; Chronic; Abdominal Pain; Child

MeSH Terms

Abdominal Pain/*etiology/ultrasonography
Child
Constipation/*etiology
Diagnosis, Differential
Female
Humans
Intussusception/diagnosis/*etiology/surgery
Lymphoma, Large B-Cell, Diffuse/*complications/*diagnosis
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Plain abdominal radiographs taken in the emergency room 3 days before visiting the outpatient clinic showed mild to moderate ileus without definite mechanical obstruction. (A) Erect view. (B) Supine view.

• 

  Fig. 2 Abdominal ultrasonography of the right upper abdomen. (A) An ileocolic-type intussusception was found with a crescent-shaped hypoechoic portion (arrows). (B) Enlarged lymph nodes (*) along the intussusceptions.

• 

  Fig. 3 Abdominal computed tomography. (A) A 3-cm, crescent-shaped (arrow), low-density lesion at the top of the intussusception. (B) Ileocolic-type intussusception (arrow).

• 

  Fig. 4 Laparoscopy view showing the intussusception. Distal ileum (a) is pulled into ascending colon (b), forming ileocolic type intussuception (arrow).

• 

  Fig. 5 Gross and microscopic findings of the resected tissue. (A) Gross view of the formalin-fixed hemicolectomy specimen including ileum, cecum and appendix showing an ill-defined ulcerative lesion (arrow), measuring 5.5 × 4.0 cm. (B) The terminal ileum shows ulceration with diffuse tumor cell infiltration (arrow) in the mucosa and proper muscle layer in a low-magnification view (H&E stained, × 20). (C) The tumor cells have large vesicular nuclei with prominent nucleolus and thick nuclear membrane (H&E stained, × 400). (D) The subserosa and serosa of the terminal ileum show fibrosis and chronic inflammatory cell infiltration (arrow) admixed with tumor cell infiltration (Masson trichrome stained, × 20).

Reference

1. Malakounides G, Thomas L, Lakhoo K. Just another case of diarrhea and vomiting? Pediatr Emerg Care. 2009; 25:407–410.

2. Reijnen JA, Festen C, Joosten HJ. Chronic intussusception in children. Br J Surg. 1989; 76:815–816.

3. Singal R, Gupta S, Goel M, Jain P. A rare case of chronic intussusception due to non Hodgkin lymphoma. Acta Gastroenterol Belg. 2012; 75:42–44.

4. Yadav K, Patel RV, Mitra SK, Malik AK. Chronic secondary caeco-colic intussusception in a boy associated with primary malignant lymphoma of caecum (a case report). J Postgrad Med. 1986; 32:94–96.

5. Shakya VC, Agrawal CS, Koirala R, Khaniya S, Rajbanshi S, Pandey SR, Adhikary S. Intussusception due to non Hodgkin’s lymphoma; different experiences in two children: two case reports. Cases J. 2009; 2:6304.

6. Seo HE, Lee JH, Park TI, Lee KS. Small intestinal mucosa associated lymphoid tissue(MALT) lymphoma in a child presenting with recurrent intussusceptions: a case report. Korean J Hematol. 2007; 42:419–422.

7. Kim KN, Woo JJ, Bahk YW, Kim SY, Kang YM. High grade MALT lymphoma of the ileum in a child presenting as intussusceptions: a case report. J Korean Radiol Soc. 2002; 46:279–282.