Small Bowel Lymphoma Complicated With Ischemic Colitis: A Case Report

Abstract

Ischemic colitis is thought to be an injury to the colon as a result of reduced blood flow. Certain infectious diseases such as the Epstein-Barr virus can aid in the reduction of blood flow. The insult can range from inflammation and superficial injury to full-thickness necrosis. The typical regions affected are the "watershed" areas of the colon: the splenic flexure, the rectosigmoid junction, and the right colon. Because patients can present with a wide spectrum of symptoms from vague abdominal discomfort to complete abdominal catastrophe, the diagnosis of ischemic colitis is sometimes challenging to make. Patients typically present with the acute onset of crampy abdominal pain and usually pass blood mixed with stool within 24 hours. Endoscopically, ischemia is suspected in the presence of bluish hemorrhagic nodules from submucosal bleeding, cyanotic or necrotic mucosa with bleeding ulcerations, or a segmental distribution with an abrupt transition point between injured and normal mucosa. We present a case of an 80-year-old male with a history of hypertension, hyperlipidemia, and basal cell carcinoma of the scalp diagnosed with ischemic colitis associated with positive Epstein-Barr virus B cell lymphoma.

Keywords: b cell lymphoma; epstein barr virus; ischemic colitis; neutropenic enterocolitis; pneumatosis coli; small cell lymphoma.

Figure 1. Computed tomography (CT) showing extensive complex acute pancreatitis with stable early walled-off collection and possible early necrotizing collection (A). Anterior pancreatic gastric perforation with wall thickening and second proximal jejunum perforation near peripancreatic fluid/inflammatory change (B).

Figure 2. Colonoscopy images showing congested edematous mucosa with shallow ulcerations without necrosis.