Non-Hodgkin Lymphoma Presenting as a Rare Cause of Malignant Small Bowel Intussusceptions in Children: A Series of Three Cases

Primary malignant small intestine tumours comprise less than 2% of all gastrointestinal malignancies. Lymphoma accounts for 15-20% of all small bowel neoplasms. It is a rare cause of intussusception, and Non-Hodgkin Lymphoma (NHL) is the third most common childhood cancer. The symptoms of secondary intussusception are often vague in older children and in colonic cases, which can lead to misdiagnosis. Intestinal (as opposed to lymph nodal) involvement by lymphoma is associated with an earlier diagnosis due to abdominal symptoms. Barium enema has fallen out of favour with the advent of better and newer imaging modalities. A barium series can miss the lead point. Ultrasonography (USG) and Contrast-Enhanced Computed Tomography (CECT) are sensitive and specific in diagnosing intussusception. Fluoro-Deoxy-Glucose Positron Emission Tomography (FDGPET) of the chest, abdomen, and pelvis is highly sensitive and specific in staging lymphomas. Pre-operative determination of the etiology of intussusception in the small bowel in older children is difficult. Diagnostic challenges remain, even after investigations, in identifying a malignant lead point. Histology remains the mainstay for diagnosing malignancies. Laparotomy is the gold standard for both diagnosis and treatment. The authors emphasise the importance of early diagnosis, timely interventions, and adjuvant chemotherapy if surgical outcomes are to be improved. Survival rates and long-term follow-ups are generally favourable.