Recurrent small bowel obstruction caused by Burkitt lymphoma in an elderly man: a case report and review of the literature

Abstract

Background: Acute small bowel obstruction is a common surgical emergency usually caused by abdominal adhesions, followed by intraluminal tumors from metastatic disease. Although lymphomas have been known to cause bowel obstruction, Burkitt lymphoma is seldom reported to induce an obstruction in the adult population.

Case presentation: A 78-year-old Hispanic man with a history of abdominal interventions presented to our hospital with abdominal pain. Computed tomography revealed a partial small bowel obstruction attributed to local inflammation or adhesions. Medical management with bowel rest and nasogastric decompression resulted in resolution of symptoms and quick discharge. He returned 2 days later with worsening abdominal pain. Repeat imaging showed progression of the partial small bowel obstruction, but with an additional 1.6-cm nodular density abutting the anterior aspect of the gastric antrum and lobulated anterior gastric antral wall thickening. He was taken to the operating room, where several masses were found. Intraoperative frozen sections were consistent with lymphoma, and pathology later revealed Burkitt lymphoma. Disease was found on both sides of the diaphragm by positron emission tomography. After the initial resection and adjuvant chemotherapy, the patient is alive and well about 14 months after resection.

Conclusions: Small bowel obstruction is uncommonly due to Burkitt lymphoma in the geriatric population and is more frequently seen in the pediatric and young adult populations. Burkitt lymphoma is very aggressive with rapid cell turnover leading to significant morbidity. The rapid recurrence of an acute abdominal process should prompt an investigation for a more sinister cause such as malignancy.

Keywords: Recurrent; Small bowel obstruction; Sporadic Burkitt lymphoma.

Fig. 1

Computed tomography (CT) of the abdomen. Abdominal CT scans of first admission compared with second admission. a Partial bowel obstruction noted on first admission with transition point (arrow). b Nodular mural thickening of the anterior aspect of the gastric antrum (arrow)

Fig. 2

Frozen sections and microscopic analysis of intraoperative findings. a “Starry sky” appearance consisting of sheets of intermediate-sized lymphocytes represent the “dark sky.” The intervening dispersed histiocytes with debris (tingible body macrophages) represent the “stars” (arrows). b c-Myc stain showing a nuclear pattern. c CD20 stain showing a membranous pattern

Fig. 3

Flow cytometry. Results of flow cytometry consistent with B-cell lymphoma, which is kappa-light chain restricted with expression of CD10 and lack of CD5 expression

Fig. 4

Positron emission tomography (PET) scan. a Pretreatment PET with active lymphoma on both sides of the diaphragm, including chest adenopathy and multifocal gastric involvement in the abdomen. Yellow arrow: chest adenopathy with standardized uptake value (SUV) of 20.4. Red arrow: gastric antrum uptake with SUV of 14.1. b Post-treatment PET about 6 months after resection showing no definite evidence of lymphoma