Presentation
The patient was hospitalized for evaluation of weight loss (15 kg during the last 4 months) and recent complaints of left lower abdominal pain. Blood exams showed severe anemia (hemoglobin = 8 gr/dr). Gastroscopy and colonoscopy examinations did not show any significant pathology.
Patient Data
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Markedly dilated jejunal loop, measuring 12 cm long, with severe irregular bowel wall thickening and ulceration with perforation. Large amount of free intraabdominal air. The rest of the bowel loops are within normal limits, with contrast filling up to the terminal ileum, without signs of bowel obstruction. Prominent mesenteric lymphadenopathy.
The prostate gland is enlarged. Multiple left internal iliac chain lymph nodes and bilateral common iliac chain lymph nodes show suspicious features of enlargement and rounded shape.
Mixed lytic and sclerotic vertebral bone lesions.
The patient underwent emergent laparotomy with resection of the affected small bowel loop.
The pathology confirmed the suspected diagnosis of small bowel lymphoma.
Case Discussion
This case presents the classic imaging finding of aneurysmal bowel dilatation in small bowel lymphoma. The proposed mechanism is the replacement of the muscularis propria and destruction of the myenteric nerve plexus by the tumor.
T-cell lymphoma has a predilection for the proximal small bowel and is more likely to be associated with bowel perforation as seen in this case.
Another findings, in this case, are prostate enlargement with suspicious pelvic lymph nodes.
The vertebral bone lesions raise a differential diagnosis between infiltration by lymphoma and metastatic prostatic cancer. The patient refused further evaluation.
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