Primary small intestinal lymphoma is relatively uncommon. Small bowel tumors are difficult to diagnose, because they are usually asymptomatic in the initial phase, and they are not easily detected by traditional methods of investigating the small intestine. This case shows a successfully detected and treated gastrointestinal bleeding from rare ileal mucosa-associated lymphoid tissue lymphoma, using double balloon endoscopy. (Korean J Gastroenterol 2013;62:365-369) Clinical manifestations may

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... y from each patient, who may present with any one, or a combination of any, of the following: dyspepsia, epigastric pain, abdominal pain, nausea, vomiting, diarrhea, weight loss, malabsorption, obstruction, anemia, and to a lesser extent ulceration, perforation, and intussusceptions. [10] [11] [12] The most frequent symptoms for small bowel tumors were obscure gastrointestinal bleeding (57%), and chronic abdominal pain/diarrhea/obstruction (15%). 6 Conversely, a few patients were reportedly asymptomatic. 13 In our case, the patients had abdominal pain that persisted for 3 years, and hematochezia. Endoscopic finding showed arterial spurting in the ileum, with annular stricture. To date, only a few cases of MALT lymphoma of the small bowel have shown annular stricture. Yanai et al. 14 reported a rare case of MALT lymphoma of the small bowel with annular stricture, presumably induced by NSAID. MALT lymphomas display unusually indolent behavior, remaining localized to their site of origin for long periods of time without disseminating, a feature which has made them uniquely amenable to cure by local therapy, such as surgical excision, with or without radiation therapy. 15 Gastric MALT lymphomas, which represent up to 48% of all primary gastric lymphomas, are associated with H. pylori infection, and the eradication of H. pylori correlates with tumor regression. 16 In contrast to gastric MALT lymphoma, the relationship between small bowel MALT lymphoma and H. pylori infection has not been established; and whether H. pylori eradication may, or may not lead to lymphoma regression, has also not been established. 16,17 H. pylori test showed negative in our case. Relapses involving the small bowel are rare, unlike gastric MALT lymphoma, where, following complete remission after the eradication of H. pylori, the risk of relapse justifies life long follow-up examinations. 18 In conclusion, small bowel MALT lymphoma is a relatively rare form of gastrointestinal tumor. To date, only a few cases of small bowel MALT lymphoma have been reported, and to our knowledge, this is the first case to report small bowel MALT lymphoma complicated with annular stricture and active bleeding. Small bowel tumors are difficult to diagnose, because they are usually asymptomatic in the initial phase; and traditional methods of investigating the small intestine, such as small bowel follow-through and CT scanning, have low yield for tumors. 19 This case represents the successful detection and treatment of arterial bleeding from rare ileal MALT lymphoma accompanied by annular stricture, using DBE.