An Exceptional Case of Ileocolic Intussusception Secondary to Burkitt’s Lymphoma: What Variations Are There in the Presentation and Management of Those Patients Who Approach Adolescence?

Abstract

Intussusception is a common cause of abdominal pain among the paediatric population with up to 10% of cases occurring secondary to a pathological lead point. Burkitt's lymphoma (BL) is a highly malignant and rapidly growing B-cell neoplasm which in extremely rare cases can present as intussusception. We report a case in an otherwise healthy 15-year-old male who presented with atypical abdominal pain. Imaging subsequently indicated an ileocolic intussusception, and given that the suspicion of a pathological lead point mandates a laparotomy and bowel resection, he proceeded to surgery. The histopathology confirmed Burkitt's lymphoma as the aetiology responsible for this intussuscepted mass. A detailed discussion including a systematic review of all previous case reports explore the diagnostic dilemma of intussusceptions secondary to BL. This case report aims to highlight the clinical challenges in establishing such a diagnosis and an appreciation for the subtle variations in clinical features, as well as the differences in management between infants and adolescents.

Importance of Histopathology of Intussusception and Evaluation of Cause of Intussusception in Infants and Children- A 4 Years Study

“…Most of the cases in children affect the distal ileum/ ileocecal region. [15] Similar findings have been reported by Krish Kulendran et al [16] that shows similar findings in our study too. The intestine is the most common site of primary extranodal lymphoma, [17] the usual clinical presentation is abdominal pain and a palpable right lower quadrant mass.…”

Large-B-Cell Lymphoma causing Intussusception in a Young Male: A Challenge for a General Hospital

“…presence of a lymphoma is often observed and therefore in these cases surgery should be followed by chemotherapy. In the present case, a Burkitt's lymphoma (BL), which is a highly malignant and rapidly growing B-cell neoplasm [1] was histologically diagnosed. BL is a highly aggressive disease invading bone marrow in 35% of cases and central nervous system in 15% of patients.…”

“…Intussuception is a common condition in children, especially in those aged between 4 and 5 years old, due to a congenital laxity of mesentery, and often represents a cause of intestinal obstruction. It is called primary idiopathic intussusception in children and it is mostly treated by air enema reduction [1].…”

Telescoping intestines intussusception in adults

“…Based on their location, intussusceptions have been classified into four categories: (1) those confine to the small bowel (entero-enteric) (2) those, involving the large bowel only (colo-colic), ( 3) ileo-colic, that occurs as the prolapse of the terminal ileum within the ascending colon and (4) ileo-cecal, when the ileo-cecal valve acts as a lead point of the intussusception. While colo-colonic intussusception is predominately caused by malignancy (70% of cases), 70% of small intestine intussusceptions are caused by a benign pathology [1,5,7,9] . Considering the pathological causes of intussusception in the present study, four cases were secondary to diffuse large B cell lymphoma (DLBCL), however Yakan S et al [1] has reported one case of DLBCL.…”

“…Almost 90% of cases occur in the small or large bowel and the remaining 10% involve the stomach or surgically created stomas. Computerized tomography (CT) is often considered as one of the most useful, sensitive imaging modality in the diagnosis of intussusception [1,6,7] .…”