We are presenting a case with acute abdomen, i.e. ileoileal intusussception, caused by Burkitt lymphoma. A sixteen-year-old Caucasian Kosovar boy, presented in the surgical emergency clinic as acute abdomen, with abdominal pain, nausea, vomiting, and problems with defecation and flatulence. The symptoms started three days ago, worsening on admission day.
The patient's height was 178 cm, and his weight was 70 kg. His vital signs were: blood pressure 120/80 mmHg; pulse rate: 76 beats/min; respiratory rate 20/min; body temperature 37.1°C.
During physical examination, a distended, diffusely tender and painful abdomen with lower abdomen rebound was revealed. The patient's skin was pale with sweats.
Plane abdominal radiography showed mechanical obstruction. (Fig. )
The emergency laboratory tests presented as follows: Red blood cells (RBC): 4.61 × 109/L; white blood cells (WBC): 7.3 × 109/L; Hemoglobin (Hgb): 128 g/L; Hematocrit (Htc): 0.42; blood sugar: 5.42 mmol/L; blood urea nitrogen (BUN): 2.6 mmol/L; serum creatinine: 88 μmol/L; BUN/Creat ratio: 8.5; total protein: 72 g/L; albumin: 36 g/l; ALP: 60 IU/L; ALT: 26 IU/L; AST:40 IU/L; direct bilirubin: 5.8 μmol/L; total bilirubin: 20.5 μmol/L; indirect bilirubin: 14.7 μmol/L; Gama GT: 26 IU/L; C-reactive protein: 15.6 mg/L; serum amylase: 30 U/L: electrolytes: Na: 138 mmol/L; K: 3.75 mmol/L; Cl: 102 mmol/L; urinalysis: 2-4 Leucocytes, some bacteria and some uric acid crystals. Blood group: O Rh(D) poz.
Three weeks prior he had been surgically treated as acute abdomen caused by acute appendicitis and Mckelly Diverticulitis. Appendectomy and short resection of the ileum with diverticulum, and end-to-end anastomosis was performed. The immediate post operative period went well. After his discharge, his second hospital admission was two weeks after operation with abdominal pain and constipation problems which released spontaneously after two days.
At his third admission as acute abdomen, urgent laparotomy was performed in general endo tracheal anesthesia on the day after admission. Intra operative findings revealed small bowel dilatation, with intussusceptions of the terminal ileum, 2 cm from ileocecac valve. There were multiple enlarged mesenteric lymph nodes at the meso of the terminal ileum, ascending and the transverse colon, without palpable liver metastases.
We have done des intussusceptions caused by tumor from the wall of the ileum. (Fig. , , )
Adhesions at the anastomosis, and 60 cm above that, were released. The right extended haemicolectomy with end to end ileum-transverse anastomosis was performed. Post operative period went well; blood pressure was 120/80 mmHg, pulse rate beats: 65/min; temp.: 36.7°C. The wound healed per primam. He was treated with frozen fresh plasma (several doses-seven), red blood cells (one dose); antibiotic, analgesics, H2 blockers, vitamins, amino acids, human albumins. He was discharged on the 10th postoperative days, with good bowel movements. He was oriented to the Hematology Department for further treatment, for Burkitt Lymphoma with chemotherapy.
HP opinion: Giemsa staining demonstrated neoplastic lymphocytes infiltration. Immunochemical testing was positive for Burkitt lymphoma (CD10, CD20, CD34, Bcl-2, Ki67, IgM, MIB-1 with a proliferation index of over 90% of neoplastic cells) and c-myc translocation determined by FISH analysis (fusion and split). (Fig. , , , , )
The formula for computing Cockcroft-Gault is given by CrCl = ((140 - age) * adjusted weight * (gender_coefficient)) / (serum creatinine * 72), where the gender_coefficient is 1 if male, and 0.85 if female. The serum creatinine concentration is in mg/dL.
The patient's gender is male, which means that the gender coefficient is 1.
The patient is 16 years old. 
The concentration of creatinine is 88.0 µmol/L. We need to convert the concentration to mg/dL. Let's first convert the mass of creatinine from µmol to mg. The mass of creatinine is 88.0 µmol. To convert 88.0 µmol of creatinine to mol, multiply by the conversion factor 1e-06, giving us 88.0 µmol creatinine * 1e-06 mol/µmol = 8.8e-05 mol creatinine. To convert from mol creatinine to grams, multiply by the molar mass 113.12 g/mol, which will give 8.8e-05 mol creatinine * 113.12 g/mol = 0.01 g creatinine. To convert 0.01 g of creatinine to mg, multiply by the conversion factor 1000.0, giving us 0.01 g creatinine * 1000.0 mg/g = 10.0 mg creatinine. The current volume unit is L and the target volume unit is dL. The conversion factor is 10.0 dL for every unit of L. Our next step will be to divide the mass by the volume conversion factor of 10.0 to get the final concentration in terms of mg/dL. This will result to 10.0 mg creatinine/10.0 dL = 1.0 mg creatinine/dL. The concentration value of 88.0 µmol creatinine/L converts to 1.0 mg creatinine/dL. 
The formula for computing the patient's BMI is (weight)/(height * height), where weight is the patient's weight in kg and height is the patient's height in m.
The patient's height is 178.0 cm, which is 178.0 cm * 1 m / 100 cm = 1.78 m. The patient's weight is 70.0 kg. The patient's bmi is therefore 70.0 kg / (1.78 m * 1.78 m) = 22.093 kg/m^2.The patient's BMI is 22.1, indicating they are normal weight.
Because the patient is normal, we take take minimum of the ideal body weight and the patient's body as the patient's adjusted weight for the Cockroft-Gault Equation. Hence, the adjusted body weight is the minimum of the two giving us an adjusted body weight of 70.0 kg.

Using the Cockcroft-Gault equation:
CrCl = ((140 - age) * adjusted weight * gender_coefficient) / (serum creatinine * 72).
Plugging the patient's values gives us ((140 - 16) * 70.0 * 1) / (1.0 * 72) = 120.556 mL/min. Hence, the patient's creatinine clearance is 120.556 mL/min.