Surgical Management of Small Bowel Lymphoma

A Delayed Presentation of Perforated Diffuse Large B Cell Lymphoma of the Small Bowel Resulting in a Large Interloop Faecaloma

“…The most common symptoms of primary intestinal lymphomas include abdominal pain weight loss and anorexia, altered bowel habits, and a palpable abdominal mass as seen in our case [ 5 ]. They may present with obstruction or perforation as seen here, with small bowel being the most common site for both and these findings were associated with more aggressive subtypes of B cell lymphoma [ 1 ]. Predisposing factors for small bowel malignant tumours include inflammatory bowel disease, GIT polyposis syndromes, and celiac disease [ 2 ].…”

“…A recent retrospective study published in 2021 from a national database in the United States found that adjuvant chemotherapy following surgical resection is associated with an improved overall survival in primary small bowel lymphoma as opposed to surgery alone; however, they did exclude patients with stage IV disease and included both elective and emergency presentations making it difficult to apply to our case; however, the patient in our case did proceed to receiving chemotherapy [ 1 ]. An earlier, smaller, single centre retrospective study in 2017 also found that a combined chemotherapy and surgery approach with gross resection of tumour defined as intraoperative removal of tumour macroscopically was associated with improved overall 5-year survival [ 10 ].…”

“…Given the relative rarity of small bowel lymphomas which make up about 2% of all GIT neoplasms, there is paucity of data to guide its optimal management [ 2 ]. Of the primary small bowel neoplasms, 20% of them are secondary to primary lymphomas [ 1 ]. It is becoming more apparent that optimal treatment algorithms and survival rates of primary GIT lymphomas vary significantly based on site, with the wide range of histology affecting outcomes [ 1 ].…”

“…Of the primary small bowel neoplasms, 20% of them are secondary to primary lymphomas [ 1 ]. It is becoming more apparent that optimal treatment algorithms and survival rates of primary GIT lymphomas vary significantly based on site, with the wide range of histology affecting outcomes [ 1 ]. Majority of studies revolving GIT lymphomas have identified that B cell lymphomas are more common than T cell lymphomas with diffuse large B cell lymphoma (DLBCL) being the most common subtype and further subgroup analysis based on site has identified that these tend to have an affinity for the small bowel [ 5 ].…”

“…The incidence of primary small bowel lymphoma is on the rise in the western world albeit rare. Previous studies have often treated primary gastrointestinal lymphomas arising from varying sites as a single entity although it is becoming increasingly evident that the optimum treatment regimen and survival rates vary significantly based on site and histology [ 1 ]. Given the nonspecific symptoms at presentation, diagnosis is often delayed resulting in emergency presentations with obstruction or perforation.…”