Ileocolic Intussusception Secondary to B-Cell Lymphoma: A Case Report

A 20-year-old man with no relevant medical history presented with right lower quadrant abdominal pain for 2 months, which had worsened over the preceding 3 days. Physical examination revealed a tender, palpable mass in the right lower quadrant, while laboratory tests were unremarkable. Abdominal ultrasound demonstrated a characteristic “bowel-within-bowel” appearance, suggestive of intussusception (shown in Fig. 1). Computed tomography confirmed an ileocolic intussusception without an identifiable lead point (shown in Fig. 2).Colonoscopy revealed a 6-cm ulcerated, subepithelial polypoid lesion arising from the terminal ileum and prolapsing into the cecum, precluding further passage of the scope (shown in Fig. 3). Endoscopic biopsies were inconclusive. The patient improved with conservative management and subsequently underwent an elective laparoscopic ileocolic resection with terminal ileostomy, 3 weeks later. Histopathological examination confirmed diffuse large B-cell lymphoma with a high proliferative index (Ki-67 >95%) and negative c-MYC expression.Staging with 18F-FDG PET/CT demonstrated intense uptake with nodular configuration in the right flank/iliac fossa, corresponding to an apparent intestinal location. No hypermetabolic lymphadenopathy suspicious for metastatic disease is seen in the abdominopelvic region.The patient completed six cycles of systemic R-CHOP chemotherapy, achieving complete response on posttreatment PET imaging. Ten months after diagnosis, gastrointestinal continuity was successfully restored. He currently remains asymptomatic and in remission, under regular follow-up at the hemato-oncology clinic.Intestinal intussusception is uncommon in adults, accounting for only 1–5% of all bowel obstructions [1]. In contrast to pediatric cases, which are predominantly idiopathic, an underlying cause can be identified in up to 90% of adult cases, with neoplasms accounting for nearly 40% [1, 2]. The nonspecific nature of symptoms often delays diagnosis [1, 3], making early recognition crucial to prevent complications such as bowel obstruction, ischemia, or necrosis [3].Primary gastrointestinal lymphoma represents 1–4% of all gastrointestinal malignancies, with approximately 90% being B-cell non-Hodgkin lymphomas. Among these, diffuse large B-cell lymphoma is the most common subtype and the leading lymphoma associated with intussusception [2]. Imaging plays a central role in diagnosis, whereas surgical intervention is frequently required for both diagnostic confirmation and therapeutic management [3]. Chemotherapy remains a cornerstone of treatment for gastrointestinal non-Hodgkin lymphoma [1].Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Approval by the Ethics Committee was waived in accordance with local regulations. The CARE Checklist has been completed by the authors for this case report and is attached as online supplementary material (see https://doi.org/10.1159/000548864).The authors have no conflicts of interest to declare.This study was not supported by any sponsor or funder.Andreia Guimarães conceived and designed the manuscript (conceptualization, methodology). Patrícia Santos, António Caires, Sandra Martins, and Ângela Rodrigues contributed to the critical review of the manuscript (writing – review and editing). All authors read and approved the final version of the manuscript.All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.