Rare case report and literature review of peripheral T-cell lymphoma presenting as massive gastrointestinal hemorrhage: an unusual etiology demanding emergency surgical intervention.

We report a case of peripheral T-cell lymphoma (PTCL) initially presenting as idiopathic recurrent gastrointestinal hemorrhage, which had previously been misdiagnosed as multiple gastrointestinal ulcers. The recurrent hemorrhage proved to be refractory to conservative management. Unfortunately, the patient developed hemorrhagic shock due to massive gastrointestinal bleeding and was transferred to the intensive care unit (ICU). Emergency endoscopy revealed multiple ulcers in the duodenum and ileum, raising a strong suspicion for inflammatory bowel disease (IBD). However, the patient showed no significant improvement in response to corticosteroid therapy. After multidisciplinary consultation, intervention therapy was performed, but no evidence of contrast extravasation was observed. The patient continued to experience recurrent hematochezia and hematemesis, accompanied by profound anemia, with hemoglobin level dropping as low as 45 g/L. Subsequently, the patient's level of consciousness deteriorated, and progressive hypotension developed. Given the critical condition, emergency exploratory laparotomy was performed, which finally revealed multiple longitudinal ulcers, cobblestone-appearance mucosa, and numerous active bleeding sites throughout the large lumen of the small intestine. Consequently, partial small intestinal resection with enterostomy was carried out. Histopathological examination of the resected specimen ultimately confirmed the rare diagnosis of PTCL. Postoperatively, the patient's gastrointestinal bleeding significantly improved, and the patient was subsequently discharged. The rare case of life-threatening gastrointestinal bleeding underscores the necessity of heightened clinical awareness of PTCL to minimize misdiagnosis and delayed diagnosis, thereby facilitating timely intervention.