Recurrent Intermittent Small Bowel Obstruction as an Initial Manifestation of Primary Intestinal Diffuse Large B-Cell Lymphoma: A Case Report and Systematic Literature Review

Primary intestinal diffuse large B-cell lymphoma (DLBCL) is a rare gastrointestinal malignancy and an uncommon cause of small bowel obstruction (SBO). We report a 70-year-old man with no history of abdominal surgery who presented with recurrent episodes of abdominal pain, vomiting, and transiently resolving SBO. Serial computed tomography (CT) demonstrated a persistent transition point associated with an increasingly evident mesenteric soft tissue mass, initially suspected to represent a neuroendocrine tumor. After repeated presentations and temporary improvement with conservative management, exploratory laparotomy revealed a distal ileal tumor with central mesenteric involvement encasing major mesenteric vessels. Segmental small bowel resection with primary anastomosis was performed, although macroscopic mesenteric disease remained. Histopathological examination confirmed CD10-positive DLBCL, and systemic treatment with six cycles of R-CHOP was initiated. A structured search of MEDLINE and Embase identified 78 publications describing 87 adult cases of intestinal lymphoma presenting with SBO. DLBCL was the most frequently reported subtype, and the ileum was the most commonly specified anatomical location. However, recurrent obstruction with transient clinical and radiological improvement was rarely emphasized. This case demonstrates that temporary resolution of obstructive symptoms does not exclude a persistent pathological lead point. Recurrent SBO in a patient without previous abdominal surgery, particularly when serial imaging demonstrates evolving mesenteric or intestinal abnormalities, should prompt renewed investigation for an underlying malignancy, including intestinal lymphoma. Repeat cross-sectional imaging, multidisciplinary reassessment, and individualized consideration of operative exploration may facilitate timely diagnosis while avoiding conclusions that transient improvement represents definitive resolution.