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

Affiliations
  • 1Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul, Korea. chsh0414@khu.ac.kr
  • 2Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
  • 3Department of Pathology, Kyung Hee University Hospital at Gangdong, Seoul, Korea.

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).


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