Jejunal perforation as the first presentation of diffuse large B-cell non-Hodgkin's lymphoma during pregnancy

Background: Diffuse large B-cell lymphoma can present as either primary lymph node disease or with involvement of extra-nodal sites. In gastrointestinal involvement, the clinical presentation is often insidious, such as abdominal pain, nausea, vomiting, anemia, weight loss, fever, and occasionally small bowel obstruction or a palpable mass. Small-bowel perforation as the first manifestation or secondary to chemotherapy of non-Hodgkin's lymphoma is extremely rare. Although small-bowel perforation corresponding to diffuse large B-cell non-Hodgkin's lymphoma has been reported in literature, jejunal perforation due to diffuse large B-cell non-Hodgkin's lymphoma in an otherwise healthy pregnant woman as the first manifestation has not ever been reported. Case Report: The case of a 21-year-old pregnant woman of Caucasian origin is reported who was 27 weeks pregnant when she presented to the emergency department complaining of a generalized abdominal pain following a two-year history of intermittent abdominal pain on the left upper quadrant. Following abdominal ultrasound, a solid heterogeneous mass 113x42 mm in diameter was seen in the left upper quadrant that showed severe tenderness under probe pressure. Laparotomy was performed that revealed a focally perforated segment of the jejunum. Histological evaluation reported diffuse large B-cell non-Hodgkin's lymphoma. Conclusions: This case illustrates a rare complication of large B-cell non-Hodgkin's lymphoma of the jejunum that was responsible for small-bowel perforation and following peritonitis. This clinical pattern may appear as a leading presentation of small intestinal neoplastic disease in which surgical resection needs to be considered.