Simultaneous double ileoileal intussusception due to Burkitt's lymphoma in a young male
A 26-year-old male patient, previously healthy, presented to our ER complaining of diffuse colicky abdominal pain of one week duration. He also reported nausea, two episodes of non-bilious vomiting and a two-day history of constipation and obstipation. No fever or chills. He denied any past surgical history. His vital signs were all within normal limits. On physical examination, his abdomen was tender, distended and tympanic on percussion. Bowel sounds were hyperactive. DRE showed empty rectum. All his lab tests were normal except for mild leukocytosis. Plain abdominal film showed two air-fluid levels. A follow-up CT scan of the abdomen and pelvis showed small bowel obstruction and a 5 × 5 cm mesenteric mass (Fig. ). Another mass of 3 × 3 cm was also noted. The patient was referred for surgical management.\nUnder general anesthesia, patient in supine position, a midline laparotomy was performed. A large amount of abdominal fluid was aspirated and sent for culture and cytology. During running of the bowel at the level of 20 cm from the ligament of Treitz, an intussusception with a palpable intraluminal mass was found. Another intussusception 120 cm distal to the first was also noted (Fig. ). No other pathologies were found. Double enterectomies with end-to-end anastamoses were performed. The patient was discharged home on Day 5 post op. Pathological analysis revealed polypoid and infiltrating intraluminal lymphoid proliferation (Fig. ), extending to serosa and exhibiting diffuse aspect composed of medium-sized B-cells: pattern of Burkitt's Lymphoma. Abdominal fluid cytology analysis showed the presence of atypical lymphoid cells.