Intestinal Mature B-Cell Non-Hodgkin Lymphoma Presenting as an Acute Surgical Abdomen in Children: A Case Series

Intestinal mature B-cell non-Hodgkin lymphoma (B-NHL) is the most common pediatric gastrointestinal lymphoma, but presentation as acute mechanical bowel obstruction remains rare and still challenging. Evidence guiding emergency surgical management in children is limited to small retrospective series and case reports. This case series describes three children with intestinal B-NHL presenting with acute mechanical bowel obstruction, or intussusception. All three patients presented to the emergency department with signs of bowel obstruction and an acute abdomen, and in one patient initial diagnosis suggested appendicitis. Imaging revealed either intussusception with a lead mass or large obstructing abdominal tumors. Surgery within 8–48 h consisted of segmental bowel resection with primary anastomosis in all cases. The final diagnoses were Burkitt lymphoma in two patients and diffuse large B-cell lymphoma (DLBCL) in one. The wider literature confirms that lymphoma-related intussusception and obstructing ileal masses occur predominantly in older children, are frequently misdiagnosed preoperatively, and often require emergency surgery both for diagnosis and for treatment of obstruction. Available literature has examined outcomes after emergency surgery for intestinal lymphoma, but the present case series cannot determine its independent effect on long-term oncologic prognosis. Pediatric intestinal B-NHL can present as acute mechanical bowel obstruction or intussusception suggesting common surgical conditions. Surgeons play a crucial role in early recognition, appropriate extent of resection, and timely transition to oncologic care. Further multicenter studies are needed to optimize surgical decision-making and quantify outcomes in this rare but life-threatening presentation.