Unusual colocutaneous fistula from intussuscepted paediatric descending colon lymphoma: A very rare pathology

Occurrence of Non-Hodgkin lymphoma in the colon of children is extremely rare. Ignorance, nonavailability of experts and poverty affect management of affected patients. Descending colon and sigmoid colon are very uncommon sites for the involvement of Non-Hodgkin lymphoma and less than 10 cases involving children have been described in world literatures. A 13 year old Kanuri boy presented with 3 years of recurrent abdominal colics and distension and eventual spontaneous enterocutaneous fistula 4 days prior to presentation. Patient was chronically ill looking and grossly wasted. The abdomen was soft with a non tender suprapubic mobile mass measuring 10cm x 14 cm. There was diagnostic dilemma which was not assisted by cheap ultrasonography and patient could not afford the sophisticated CT scan and contrast enema. Exploratory laparotomy revealed colocutaneous fistula and descending colon intussusception with a huge fungating mass as the lead point confirmed histologically to be a Non-Hodgkin's lymphoma. The challenge of lack of fund affected prompt presentation and also limited decision taken on investigation and management of the patient. High index of suspicion and meticulous management of the patient in spite of the challenges led to a good outcome. This probably might be the first reported case of a descending colon lymphoma from this subregion or even in Africa.Keywords: Abdominal masses in children, acute abdomen, enterocutaneous fistula, lymphoma, poverty, ignorance and neglect, scarcity of specialists