A Case of Lympho-Sarcoma of the Small Intestine

CASE REPORT Mr. J. M. S., a surveyor aged 45, suffered from indigestio-n for many years. During the war his dyspepsia was investigated on several occasions and in Cairo in 1944 he had a barium meal examinationi, but no evidence of peptic ulcer was discovered. Because of the repeated negative findings at clinical and radiological examination he was considered to be suffering from nervous dyspepsia. At times he complained of episodes of colicky abdominal pain and he himself thought that he might be suffering from appendix colic. It was not until November 1958, that the pattern of his symptoms changed and he observed that the abdominal colic was followed by vomiting and the passage of loose bowel motions. On the 4th March, 1959, while at work at his office desk he felt faint an-d subsequently had melaena. He was admitted to St. Thomas' Hospital at which time his haemoglobin had fallen to 70 per cent., but with conservative management on an ulcer regime his condition rapidly improved and after two weeks the haemoglobin level reached 84 per cent. Barium meal showed pylorospasm but no peptic ulcer. Later the same year, on 26th Oictober, he was admitted to Croydon General Hospital with a more severe episode of melaena, in which his haemoglobin fell to 57 per cent. and a transfusion of four pints of blood was given. Barium meal again did not show peptic ulceration, but in view of the long history of dyspepsia with repeated melaena and occasional episodes of hunger pain, it was considered likely that he was suffering from duodenal ulcer. He was discharged from hospital after three weeks on a strict post ulcer regime. During the period 1960 to 1963, he continued to have episodes of colicky abdominal pain with sickness and diarrhoea. This occurred as often as six times a year, and during many, but not all, of these attacks he had melaena. He did not sek further medical advice until the 10th December, 1963, when he was admitted during an asymptomatic period to the Friarage Hospital, Northallerton, for investigation. The results of these investigations were as follows: Barium meal and follow through examnation: The oesophageal hiatus was normal and there was no oesophageal reflux on tilting the patient. The stomach and duodenum were normal and there was no evidence of peptic ulcer. Using a small bowel technique no abnormality was detected in the jejunum or ileum and centainly nothing to suggest Crohn's disease.