Chronic ileocolic intussusception due to transmural infiltration of diffuse large B cell lymphoma in a 14-year-old boy: a case report

Abstract

Chronic intussusception, defined as intussusception continuing over 14 days, is rare in children. We herein report a case of chronic ileocolic intussusception caused by the transmural infiltration of diffuse large B cell lymphoma in a 14-year-old boy. The patient had been suffering from anorexia and intermittent abdominal pain for 5 weeks, during which his body weight decreased by around 7 kg. Upon admission to our hospital, ultrasonography and enhanced computed tomography (CT) of the abdomen showed ileocolic intussusception. A retrospective examination of abdominal CT led us to suspect that the intussusception had initially appeared 5 weeks before admission, presumably coinciding with the beginning of the patient's abdominal symptoms. Since hydrostatic reduction was unsuccessful, laparotomy was performed, which showed unreducible ileocolic intussusception with a marked edematous ileum and mesentery. Ileocecal resection without lymph node dissection was carried out, and a histological examination of the resected specimen revealed the transmural infiltration of diffuse large B-cell lymphoma of the terminal ileum. The patient's postoperative course was uneventful, and adjuvant chemotherapy was administered. This case illustrates the diagnostic challenges of confirming 'chronic' intussusception in older children.

Keywords: Chronic intussusception; Lymphoma.

Figure 1

Preoperative images. a Ultrasonography showed the “target sign” in the lower abdomen. b Enhanced CT revealed ileocolic intussusception and stretched mesenteric vessels. c The outer wall of the area of intussusception consisted of an edematous ileum (inner layer; black arrow) and dilated colon (outer layer; white arrow). d An enema examination showed “crab’s claw sign” in the transverse colon.

Figure 2

Abdominal CT at previous clinic. This CT was performed 5 weeks before he admitted to our hospital. Retrospectively, intussusception could be pointed out (arrow).

Figure 3

Intraoperative findings. a Ileocolic intussusception was confirmed. Laparoscopic reduction failed. b The mesentery was markedly thickened, and the ileum was edematous. Although the tumor (arrow) in the terminal ileum was partially reduced, manual reduction was unsuccessful. Ileocecal resection was performed.

Figure 4

Resected specimen. a The tumor (black arrow) was located on the antimesenteric side 2 cm oral to the ileocecal valve. The mucosa of the ileum was markedly edematous and erosive (arrowhead). b The tumor was hard and contained a white section. The shape of the tumor was distorted, especially in the ileal serosa.

Figure 5

Representative histological images of the tumor cells in the resected specimen. a Hematoxylin–eosin (HE) stain. b–d Immunohistochemistry. b CD20. c BCL2. d TdT. Positive cells stained brown on immunohistochemistry. Original magnification ×400. Bar 50 μm.