The case of ileocecal intussusception due to Burkitt’s lymphoma in a child

Abstract

In the practice of a doctor, rare, casuistic diseases occur, accounting for less than 5% of all lesions of an organ. Single cases of intussusception in a child owing to Burkitt’s lymphoma have been described. The child Dmitry S., 12 years old, complained of abdominal pain, repeated vomiting, loose stools, and anorexia. He was sick for 3 days. The father accidentally discovered a tumor in in the right half of the child’s abdomen. At admission, the condition is grave due to intoxication. Pronounced asymmetry of the abdomen due to the formation was revealed. Examinations: CT of the abdominal cavity - abdominal mass in the right half of 120´70´90 mm in size, enlarged mesenteric and retroperitoneal lymph nodes, ultrasound of the abdominal cavity - intussusception of 72´60´50 mm, consisting of intestinal loops and lymph nodes. Preliminary diagnosis - tumour of the abdominal cavity? Intussusception. At laparotomy, tumor biopsy, omentum resection, terminal ileostomy and peritoneal drainage were made. The large omentum was totally affected having multiple nodular elements. The ileocecal zone was affected by the total tumorous process. Intussusception was found in the ascending colon. Disinvagination was determined to be not possible. The extensive tumor spread to the entire mesentery and walls of the small intestine. The parietal peritoneum was involved in the neoplastic process up to the diaphragm. Thrombohemorrhagic changes in the mesenteric vessels in the basin of a.ileocolica and the transitional phenomenon of the necrobiosis in the segments forming the invagination were revealed. Taking into consideration the foregoing, removal of the tumor and intussusception had been considered to be impossible. Biopsy was taken and the large omentum resected. The distal ileum was resected for examination and the terminal ileostomy applied in the proximal part. A «second look» re-exploration was planned in 48 hours. Aspiration biopsy of the bone marrow was performed. At relaparotomy in 2 days necrosis of the intestinal loops composing the intussusception was revealed due to thrombosis of the mesentery vessels. Right-sided hemicolectomy was performed. The results of histological study: lymphoblastic lymphoma with total large omentum infiltration, lesion of the walls of the removed intestinal fragments. Atypical cells were not found in the bone marrow. The child wss consulted in the Institute of Oncology. There was established the clinical diagnosis - Burkitt’s lymphoma, stage IV, therapeutic group 2, subgroup R3, total infiltration of the omentum, lesion of the wall and mesentery of the small intestine and ileocecal angle, retroperitoneal space, parietal peritoneum. Ileo-colonic intussusception with necrosis, terminal ileostoma. For further treatment, the child was sent to the hematology department.