We herein report a rare case of a massive upper gastrointestinal (GI)
bleeding, caused by high-grade diffuse
B-cell lymphoma of the duodenum, secondary to
immunoproliferative small intestinal disease (
IPSID) and treated with an emergency partial
pancreatoduodenectomy. A 42-year-old man was admitted to our hospital because of
hematemesis. Upper GI endoscopy was unrevealing because of the copious
bleeding. Initially, the patient underwent
conservative treatment, thus resulting in the temporary cessation of the
bleeding. Later, the
hemorrhage massively relapsed. An urgent abdominal ultrasound raised the suspicion of a large, possibly
bleeding,
neoplasm of the duodenum, which was finally confirmed by abdominal computed tomography. The patient underwent an emergency
laparotomy, during which a partial
pancreatoduodenectomy was performed (Whipple procedure). Histologically, the
tumor was a high-grade
B-cell lymphoma of the duodenum. The nearby small intestinal mucosa was suggestive of
IPSID. A massive upper GI
hemorrhage from a high-grade B-cell
non-Hodgkin lymphoma of the duodenum, which develops secondary to
IPSID, is a very rare clinical demonstration of this disease. Our case is one of the few reports in the English literature, for which the Whipple procedure has been performed as a curative treatment.