2020 Volume 70 Issue 3 Pages 255-260
A 76-year-old man visited our hospital complaining of anorexia and abdominal bloating. At the first visit, there was no tenderness in the abdomen. Blood tests showed a slight increase in inflammatory response and LDH, and a significant increase in soluble IL-2 receptor, and abdominal CT showed a very large mass in the lower abdomen that was irregularly and unevenly enhanced. The mesentery, including the superior mesenteric artery and vein, was compressed by the mass. This is called the sandwich sign. From this characteristic finding, we diagnosed it as a mesenteric malignant lymphoma. Contrast-enhanced CT revealed ischemia in the small intestine. Abdominal pain worsened after hospitalization, and emergency surgery was performed. The ileum was necrosed over 20 cm, and the ileocecum and about 100 cm of the ileum were resected together with the tumor. The pathological diagnosis was diffuse large B-cell lymphoma (DLBCL). According to clinical guidelines, treatment of DLBCL is based on chemotherapy and radiation therapy. However, as in this case, rapid tumor growth may restrict intestinal blood flow and may require emergency surgery.
