SPONTANEOUS RUPTURE OF EXTRALUMINAL SMALL BOWEL HAEMOTOLYMPHOID MALIGNANCY PRESENTING AS ACUTE ABDOMEN AND HAEMOPERITONEUM – A CASE REPORT

ABSTRACT: Spontaneous hemoperitoneum is a relatively uncommon entity and can be life threatening.  It usually happens in patients with coagulation abnormalities due to hepatic, splenic, vascular or gynaecologic pathologies .The involvement of small bowel as a site for primary gastrointestinal lymphoma is rare. Here we are presenting a case of extra luminal small bowel haematolymphoid malignancy presenting in emergency as spontaneous hemoperitoneum. A 61 year old male with no history of trauma and a known diabetic, hypertensive and coronary artery disease presented to our casualty with sudden onset pain abdomen for 3 days and breathlessness for 1 day. Examination revealed severe pallor and tachycardia. Patient was tachypnoeic and per abdomen examination revealed lower abdominal tenderness. There was no mass palpable in the abdomen. Investigation showed severe anaemia (Hb-6.1) and metabolic acidosis. Coagulation parameters were normal. Usg showed 14 x 7 cm sized heterogenous collection with thick septa and diagnostic aspirate from the collection showed only serous straw coloured fluid. In view of deranged RFT and a clinical suspicion of gut gangrene, a diagnostic peritoneal lavage done which showed frank haemoperitoneum and the patient was posted for emergency laparotomy. Laparotomy revealed 2 litres of hemoperitoneum and an extraluminal growth on the serosal surface of ileum about two feet from ileocaecal junction. Around 2 feet of small bowel containing the growth was resected and double barrel ileostomy was done. Post op histopathological examination revealed diffuse scattered small lymphoid cells with areas of necrosis. IHC revealed tumor cells positive only for CD 45 (Leucocyte common antigen) and vimentin and a probability of small bowel hematolymphoid malignancy was suspected. Small bowel lymphoid malignancy presenting as spontaneous haemoperitoneum is a relatively rare entity and should be borne in mind to investigate and manage early.