A case of fistula of the colon and fatal salmonella sepsis in advanced Hodgkin's lymphoma |
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Authors: | M Zer MD U Mintz MD D Kaznelson MD DMD M Dintsman MD |
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Institution: | (1) Department of Surgery A and Department of Oncology, Beilinson Medical Center, Petah Tiqva;(2) The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel |
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Abstract: | A case of rapidly progressing Hodgkin's lymphoma is described in which two uncommon complications were observed. Perforation of the cecum due to lymphomatous invasion occurred with subsequent cecosigmoid fistula and pelvic abscess.Salmonella paratyphi B septicemia, refractory to all treatment, caused death of the patient approximately 2 years after initial diagnosis. The relevant literature is reviewed and the possible role of impaired function of immunological mechanisms due to both the malignancy and its treatment in exposing the patient to opportunistic infections is discussed. Although the complications in this patient were treated by further radiation therapy, antibiotics and supportive measures, early surgical intervention is probably the treatment of choice for complications of lymphomatous invasion of the gastrointestinal tract, so as to reduce undue exposure to the dangers of septic complications.
Résumé Présentation d'un cas de lymphome type Hodgkin à évolution rapide et avec deux complications inhabituelles: (1) perforation du caecum par infiltration lymphomateuse, avec fistule caeco-sigmoÏdienne et abcès pelvien; (2) septicémie à Salmonella para-B résistant à tout traitement et responsable du décès 2 ans après le diagnostic. La littérature est revue: il est possible que la dépression immunitaire due tant à la tumeur qu'au traitement favorise les infections opportunistes chez ce type de malades. Dans notre cas, les complications ont été traitées par radiothérapie et antibiotiques. Mais l'opération précoce est vraisemblablement le traitement de choix des complications dues à l'atteinte lymphomateuse du tube digestif: elle réduira le danger de complications infectieuses. |
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