Rare intestinal fistula caused by primary lymphoma of the gastrointestinal tract

Abstract

Rationale:Primary lymphoma that arises from the intestine is an uncommon malignant tumour, while intestinal fistula caused by primary lymphoma is even rarer. Non-specific clinical performance makes early diagnosis difficult, although imaging modalities might play an essential role in the detection of intestinal fistula.Patient concerns:Patient 1: A 60-year-old male hospitalized with diarrhoea and abdominal pain for seven months underwent computed tomography enterography (CTE) that demonstrated ileum internal fistula and ileac-sigmoid colon fistula. Ultrasound (US) showed small intestinal wall thickened and development of a fistula of the sigmoid colon due to malignance. Patient 2: A 43-year-old male presented with abdominal pain and diarrhoea lasting one year. US revealed a fistula between the sigmoid colon and the ileum, and CTE showed that the wall of the partial sigmoid colon was abnormally thickened and enhanced with an ileal-sigmoid fistula that strongly suggested the diagnosis of lymphoma.Diagnoses:Both the two patients were diagnosed as intestinal fistula caused by primary non-Hodgkin's intestinal lymphoma.Interventions:The patient 1 underwent surgery followed by chemotherapy. The patient 2 accepted chemotherapy.Outcomes:Two patients’ general conditions remained stable and the imaging revealed no recurrence after follow-up of about 12 months.Lessions:Cross-sectional imaging, such as US and CT, plays an essential role in intestinal lymphoma fistula diagnosis.

Ileo-Colonic Fistula Due to Diffuse Large B Cell Lymphoma: Unusual Presentation of a Rare Disease

“…Small bowel lymphoma is reported as the cause of less than one percent of all gastrointestinal malignancies, and in the absence of prior chemotherapy, surgical resection, or recent radiotherapy, the development of fistula is extraordinarily rare [ 7 ]. Nine primary lymphoma cases causing entero-colic fistula have been reported in literature; six are of B cell origin and three of T cell origin [ 6 , 7 , 11 ].…”

“…There is currently no unified consensus on the optimal treatment strategy for intestinal lymphoma fistulas [ 16 ]. Zhuang et al described a case of DLBCL with an ileo-sigmoid fistula treated with eight cycles of standard chemotherapy and no surgical intervention, with complete resolution of fistula on repeat CT imaging [ 6 ]. Milburn et al piloted a novel approach that employed endoscopic duodenal stenting, allowing for the early introduction of chemotherapy that successfully resolved the fistula [ 17 ].…”

“…Although mostly a nodal disease, 40% of cases of DLBCL involve extranodal sites such as the gastrointestinal tract [ 4 , 5 ]. Tumor intestinal fistulas are rare but serious complications of advanced primary intestinal lymphoma like DLBCL, with a paucity of reported cases [ 6 , 7 ]. We present a case of an ileo-colonic fistula due to primary DLBCL of the ileum in a 55-year-old male, followed by a case discussion and literature review.…”

Fistulae involving the appendix: a systematic review of the literature

“…Benign neoplasms include neuroma and villous adenoma. No case of primary appendiceal fistula from lymphoma has been reported, despite its known propensity to form enteric fistulae …”

“…No case of primary appendiceal fistula from lymphoma has been reported, despite its known propensity to form enteric fistulae. 167 Iatrogenic Iatrogenic causes of appendiceal fistula formation include previous vascular repair that was either open or endoluminal. Other such causes include previous groin hernia repair, gastroenterostomy, hysterectomy and foreign body (retained surgical sponge, post traumatic 77 ).…”