Adult Burkitt's lymphoma presenting as intussusception: first UK case report

Abstract

Colonic intussusception is rare in adults and can present with non-specific symptoms that can make diagnosis difficult and delayed. Unlike in children, it is commonly due to a pathological lead point that is often malignant. This case is the first reported case of adult intussusception due to Burkitt's lymphoma in the UK. We describe the case of a 22-year-old woman who presented with 4-week history of intermittent epigastric pain. On the third hospital admission, the diagnosis was made by abdominal computed tomography, which showed the 'target' sign, suggestive of intussusception. A right hemicolectomy was performed and histology later confirmed Burkitt's lymphoma. This case demonstrates the difficulty in diagnosing intussusception in adults, which must be considered in recurrent abdominal pain when more common causes have been ruled out. The rare diagnosis of Burkitt's lymphoma made early diagnosis and treatment important.

Keywords: Abdominal pain; Adult; Burkitt’s lymphoma; Early diagnosis; Intussusception.

Figure 1

Plain abdominal x-ray performed prior to computed tomography showing no definite abnormality or small bowel obstruction.

Figure 2

Coronal abdominal computed tomography: lead point mass at level of ileocaecal valve (blue arrow); adjacent lymph nodes within fatty mesentery (yellow arrow); small bowel being held up at point of intussusception (green arrow); concertina effect of right colon bowel wall within transverse colon (red arrow).

Figure 3

Abdominal computed tomography: sagittal images demonstrating typical ‘target sign’ of intussusception in proximal transverse colon.