S5983 When Trauma Isn't What It Seems: A Case of Burkitt Lymphoma Masquerading as Abdominal Injury

Introduction: Burkitt's lymphoma is a highly aggressive B-cell non-Hodgkin lymphoma predominantly affecting children and adolescents. It often presents with rapidly enlarging abdominal mass, causing symptoms such as pain, distension, and bowel obstruction. Distinguishing Burkitt lymphoma from other causes of acute abdominal symptoms, including trauma and infection, can be challenging, especially when there is a history of recent injury or gastrointestinal illness. Early and accurate diagnosis is critical, as Burkitt lymphoma requires prompt chemotherapy initiation to improve outcomes. This case highlights the diagnostic complexity when Burkitt lymphoma presents with imaging and clinical features mimicking traumatic abdominal injury in a young child. Case Description/Methods: This is a case of a 5-year-old previously healthy male, presenting with progressive abdominal pain, distension, and early satiety following an abdominal trauma while playing with his siblings. Initial imaging suggested grade 4 liver laceration with hemoperitoneum. However, further imaging revealed significant bowel wall thickening, omental “cake-like” thickening, and free fluid without clear hepatic injury. Biopsy of the mesenteric lesions confirmed Birkitt lymphoma. Subsequent staging and treatment were initiated per pediatric oncology protocol. Discussion: This case underscores the diagnostic challenge in differentiating between traumatic abdominal injury and intra-abdominal malignancy in pediatric patients presenting with abdominal symptoms. Imaging findings of peritoneal thickening and free fluid can mimic hemoperitoneum secondary to trauma but may represent carcinomatosis. Early biopsy and multidisciplinary evaluation are critical for accurate diagnosis, management and better outcomes.