Intestinal T-cell lymphoma not otherwise specified presenting with Jejunal perforation: a case report and review of the literature

Abstract

BACKGROUND: Primary gastrointestinal lymphomas are rare, with the small intestine being the second most frequently involved site after the stomach. Intestinal perforation is an uncommon but severe complication, occurring in 5-10% of intestinal lymphoma cases. CASE PRESENTATION: We report the case of a 70-year-old North African woman who presented with acute generalized abdominal pain, vomiting, and fever. Clinical examination demonstrated signs of peritonitis, which were corroborated by abdominal CT showing pneumoperitoneum with intraperitoneal fluid collection, a suspected perforation at the duodenal bulb, circumferential wall thickening in the antrum-pyloric region, and thickening of the distal ileal loop. These findings were initially interpreted as a duodenal bulb perforation; however, exploratory laparotomy revealed two jejunal perforations associated with an adjacent mass. A segmental jejunal resection with primary anastomosis was performed. Histopathological and immunohistochemical studies established the diagnosis of intestinal T-cell lymphoma. This entity is a rare and aggressive malignancy that can present with life-threatening complications such as perforation. Because clinical and radiological features are often nonspecific, preoperative diagnosis is challenging. Definitive diagnosis requires histopathological confirmation, with immunohistochemistry playing a pivotal role in accurate classification. In cases complicated by perforation, timely surgical intervention is essential, followed by systemic chemotherapy. CONCLUSIONS: Intestinal T-cell lymphoma often presents with nonspecific symptoms, which may lead to delays in diagnosis. Perforation represents a life-threatening complication that necessitates urgent surgical intervention.