Case Report

Diagnosis of Marginal Cell Lymphoma of Small Intestine by Double Balloon Enteroscopy

Authors: Kamini Giri, MD, Cynthia Sudar, MD, Mukul Arya, MD, Gregory Haber, MD, Pradeep Chandra, MD

Abstract

A 65-year-old woman with a medical history of diabetes mellitus type 2, hypertension, an old cerebrovascular accident, and seizure disorder presented to the emergency room with lower abdominal pain of 4 weeks duration. Upon physical examination, her abdomen was soft and bowel sounds were present, but there was diffuse tenderness in her lower abdomen with some guarding. A computed tomography scan of her abdomen with oral and intravenous contrast showed significantly thickened small bowel loops with subjacent lymphadenopathy. Biopsies obtained during esophagogastroduodenoscopy and colonoscopy showed acute and chronic inflammation. A double balloon enteroscopy (DBE) was then performed, which showed stricture in the jejunum from which the biopsy was obtained. The biopsy showed marginal cell lymphoma. The patient is presently undergoing chemotherapy. Double balloon enteroscopy is a new elegant endoscopical technique that seems promising, as the endoscopist can reach undiscovered small bowel segments. It seems to be well tolerated and safe. For the first time, it provides the means to endoscopically investigate and treat disorders of the small intestine that have previously been inaccessible to conventional endoscopy.


Key Points


* Double balloon enteroscopy is a new endoscopic technique that provides the gastroenterologist with an opportunity for further evaluation and treatment of abnormalities detected in small intestinal imaging studies.


* It is a promising technique, as the endoscopist can reach undiscovered small bowel segments.


* For the first time, it provides the means to endoscopically investigate and treat disorders of the small intestine that have previously been inaccessible to conventional endoscopy.

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