Unusual finding in terminal ileum. The importance of ileocecal valve intubation

Case: A 64-year-old man with no relevant history of dizziness and cervicalgia of a month and a half of evolution, in whom normocytic anemia (9.8 g/dL) and positive fecal occult blood were detected, and endoscopic studies were requested on an outpatient basis. However, the patient went to the emergency room before these tests were performed due to frank rectorrhagia with syncopal episode associated with constitutional syndrome. An abdominal CT scan was completed, showing an ileal thickening of 12.3 x 9.2 cm with no signs of active bleeding and no other associated lesions. Colonoscopy revealed a large mameloned and ulcerated mass, not stenosing, at terminal ileum (2-3 cm from ileocecal valve). Pathologic anatomy was conclusive for primary diffuse large B-cell lymphoma (DLBCL) in terminal ileum. Referral to hematology and chemotherapy was initiated [1] [2] [3].

Discussion: DLBCL is the most common histologic subtype of non-Hodgkin's lymphoma (approximately 25%). Gastrointestinal tract lymphoma is usually secondary to extranodal disease, while primary gastrointestinal tract lymphoma is relatively rare, accounting for 1-4% of malignancies arising, with the small bowel being the predominant site. This case is unique given the low incidence and clinical variety of this entity. When faced with clinical manifestations of rectorrhagia, it is essential to make a broad differential diagnosis, emphasizing the importance of always intubating the ileocecal valve to complete the study.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Foss HD, Stein H. Pathology of intestinal lymphomas. Recent Results Cancer Res 2000; 156: 33-41
• 2 Simões AB, Baruffi GD, Pauletti MGT, Valentini Junior DF. Adult ileocolic intussusception due to primary diffuse large B-cell lymphoma Rev Esp Enferm Dig. 2023; 117 doi:10.17235/reed.2023.9809/2023.
• 3 Rumney S, Rajesh A, Brigmon E. Primary gastrointestinal diffuse large B-cell lymphoma presenting as ileal perforation Cureus. 202; 15 doi:10.7759/cureus.37341.

Publication History

Article published online:
27 March 2025