SHM Converge Scientific Abstract ePoster Gallery-Small Bowel Perforation From a B Cell Lymphoma

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An 80-year-old woman with atrial fibrillation and prior gastrointestinal bleeding presented with hematochezia, anemia (Hgb 7.3 g/dL), and significant unintentional weight loss (25 lb). Initial evaluation showed marked leukocytosis, splenomegaly with an indeterminate splenic lesion on ultrasound, and a 3 cm left periaortic lymph node on CT. During hospitalization, she continued to have bloody diarrhea, and a heparin drip was started to improve the sensitivity of a planned tagged RBC scan.<br /><br />Her condition rapidly worsened while on heparin, with acute mental status decline, severe abdominal pain, and signs of peritonitis. Repeat CT revealed new pneumoperitoneum and free intraperitoneal fluid, prompting emergent exploratory laparotomy. Surgeons found a perforated small bowel mass, which was resected.<br /><br />Final pathology demonstrated diffuse large B-cell lymphoma (DLBCL), specifically an aggressive double-expressor subtype with a high Ki-67 index (95%). The case is notable because the lymphoma initially mimicked a gastrointestinal bleed rather than presenting with a more typical lymphoma syndrome. Although the GI tract is the most common extranodal site for non-Hodgkin lymphoma, perforation is a rare but serious complication.<br /><br />The report emphasizes that DLBCL, while potentially curable, carries a poor prognosis in older patients with aggressive biologic features such as MYC/BCL2 overexpression. In this patient, advanced age, frailty, and postoperative debility made definitive lymphoma treatment impractical. Palliative care was consulted, and after discussion with family, the patient was terminally extubated five days later.<br /><br />Overall, the case highlights the importance of considering underlying malignancy in patients with GI bleeding, weight loss, leukocytosis, and abnormal imaging, even when an acute bleeding source is the initial concern.

Asset Subtitle

Aymen Baig

Meta Tag

Author List Aymen Baig, Hunter Stallard, Jack Badawy, Mohammed B. Altaee, Patton McClelland, Reshma Jadhav, Sofia Ares Muzquiz

Category Clinical Vignettes

Concept Gastrointestinal Lymphoma

Concept Diffuse Large B-Cell Lymphoma

Concept Gastrointestinal Bleeding

Concept Urgent Stabilization

Concept Surgical Management

Distinguished Non-Finalist

Presenter Organization The University of Texas Health Science Center at San Antonio

Presenting Author Aymen Baig

Track Adult

Keywords

diffuse large B-cell lymphoma

DLBCL

gastrointestinal bleeding

small bowel perforation

hematochezia

splenomegaly

leukocytosis

weight loss

double-expressor subtype

palliative care

Gastrointestinal Lymphoma

Diffuse Large B-Cell Lymphoma

Gastrointestinal Bleeding

Urgent Stabilization

Surgical Management