Colo-enteric fistula associated with diffuse large B cell lymphoma that resulted in gastrointestinal bleeding: A case report and literature review

• Published in: International journal of surgery case reports Vol. 91; p. 106798
• Main Authors: Chiang, Shih-Wei, Chiang, Tzu-Wei
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.02.2022; Elsevier
• Subjects: Case Report; Colo-enteric fistula; Gastrointestinal bleeding; Primary gastrointestinal lymphoma; GI; DLBCL; SMA; FL; Primary gastrointestinal lymphoma; MLP; CT; Colo-enteric fistula; Case report; NHL; EATL; CTE; Gastrointestinal bleeding; MCL; TAE; MALT
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2022.106798

The most common symptoms of primary gastrointestinal (GI) lymphoma are non-specific, such as nausea, vomiting, diarrhea, weight loss, and abdominal pain. The rare acute symptoms include bowel obstruction, intussusception, and perforation. Primary small bowel lymphoma accounts for the smallest proportion of all GI malignancies. We report a case of intestinal lymphoma presenting with bloody stools and anemia. The patient initially underwent both duodenoscopy and colonoscopy with negative findings. Isotopic red blood cell (RBC) scan was then performed due to persistent bleeding along with computed tomography angiography (CTA) because of suspected bleeding in the left abdomen. Successful embolization over the arcade of the sigmoid and left colic arteries was performed. However, the bleeding did not stop, and ischemic colitis was diagnosed by repeat colonoscopy. A coloenteric fistula was finally discovered during emergent laparotomy. GI lymphomas are a rare disease entity among the all GI malignancies. Despite acute abdominal symptoms including obstruction, perforation, bleeding and intussusception, enteral fistula is also one of the complications. It was seen to be a long-term complication after treatment or disease process in most of cases, however it could occur as the initial manifestation. GI bleeding is a life-threatening condition and commonly needs prompt decision making. There were no standard managements for these patients, it depends on clinical judgements from physician individually. This is a rare condition that has not been previously described in Taiwan. Early diagnosis and timely management will decrease morbidity and mortality in the GI lymphoma population. •Gastrointestinal (GI) lymphomas is a rare disease entity among the all GI malignancies.•Despite acute abdominal symptoms including obstruction, perforation, bleeding and intussusception, enteral fistula is also one of the complications.•Early diagnosis and timely management will decrease morbidity and mortality