Cecal obstruction: a rare presentation of childhood intestinal lymphoma in a South Sudanese child: a case report

Introduction and importance: Primary colonic lymphoma, a rare disease, is seldom encountered in children, infrequently causing an acute abdomen that requires surgical intervention. The true incidence is unknown, and early diagnosis is uncommon due to its rarity and variable clinical presentation. We report a case of a pediatric cecal lymphoma incidentally discovered during laparotomy. Case presentation A 5-year-old boy presented with severe abdominal pain, distension, vomiting, and fever. His clinical presentation and imaging suggested intestinal obstruction. Laparotomy revealed a large cecal mass, mesenteric lymphadenopathy, and a histopathologic finding of primary non-Hodgkin’s lymphoma (NHL). Clinical discussion Primary lymphoma of gastrointestinal (GI) tumors is rare in children, with a peak age of 5–15 years. NHL in children includes lymphoblastic, Burkitt, diffuse, and anaplastic types. Symptoms include abdominal pain, abdominal distension, vomiting, constipation, diarrhea, and sometimes bowel obstruction. Case series from India and Bangladesh reported that bowel lymphoma in children preferentially involves the ileum, followed by the ileocolic region, and is rarely limited to the cecum. Emergency surgery is often necessary for palliation and diagnosis through biopsy, as well as for removing symptomatic limited disease from an affected organ. There is still no consensus on the best treatment for symptomatic limited disease affecting an organ or the timing of chemotherapy. Conclusion The case report emphasizes the importance of pediatric cecal obstruction due to B-cell NHL as a differential diagnosis for intestinal obstruction in children. Thus, pediatricians should also keep in mind the rare causes, especially in children presenting beyond the typical age-group of idiopathic intussusceptions, as GI lymphoma needs to be ruled out.