Intestinal perforation that developed after chemotherapy in a patient diagnosed with non-Hodgkin lymphoma: A case report and review of literature

IntroductionNon-Hodgkin Lymphomas (NHL) appear with the malign transformation of mature lymphocytes. Intestinal perforations are one of the most well-known complications of NHLs. In this review, a 29-year-old male patient who was diagnosed with NHL with gastrointestinal involvement that developed intestinal perforation after chemotherapy is presented.Presentation of caseA 29-year-old male patient who received systemic chemotherapy in another healthcare center due to Major B-Cell Lymphoma was examined because he had stomachache after the treatment. The patient was urgently taken to operation. In the exploration, there were partly mass lesions in all small intestine segments. It was determined that one of the lesion was perforated. Small intestine resection was applied. The pathology report on resection material was reported as High Grade Major B-Cell Lymphoma.DiscussionIn the treatment of Lymphoma with intestinal B-Cells, there is no consensus because this disease is rarely observed. Perforation may appear as a complication of the chemotherapy. Depending on the steroids given to the patient, perforation may develop, and the clinical symptoms may be masked.ConclusionIt must be born in mind that there may be intestinal involvement in patients diagnosed with NHL, and intestinal perforation may develop due to chemotherapy.     

Intestinal perforation secondary to intestinal Burkitt lymphoma

Introduction and importanceSmall intestinal perforation in patients with Burkitt lymphoma is extremely rare. We present the first report of such a case.Case presentationA 53-year-old woman was admitted with abdominal pain and vomiting. Abdominal examination revealed rigidity and tenderness in the upper abdomen.Computed tomography scan showed thickening of the wall of the jejunum, intra-abdominal free gas, and ascites; the patient was diagnosed with small intestinal perforation, and underwent emergency surgery on the same day. Laparoscopic findings were a 50 mm jejunal perforation and perforation in the transverse mesocolon. A partial jejunal resection of the perforated area, partial transverse colectomy, temporary colostomy, and intra-abdominal drainage were performed. Histological examination showed diffuse infiltration of medium-sized atypical lymphocytes in the perforated area, exhibiting a “starry sky” appearance.Immunostaining results showed that the atypical lymphocytes were CD20 and virtually 100% Ki-67 positive, and CD56, CD30, and EBER negative. The lesion was identified as Burkitt lymphoma (BL). The postoperative course was favorable. On postoperative day 18 the patient began chemotherapy through the hematology department. Currently, the patient is in remission.Clinical discussionThe majority of the malignant lymphomas occurring in the digestive tract are identified in the stomach; over 90% are B-cell lymphomas and mucosa-associated lymphoid tissue lymphoma Nakamura et al. BL originating from the small intestine accounts for only about 9%.ConclusionThe incidence of BL in the small intestine is low. Pretreatment BL can lead to bowel perforation. Prompt involvement of the hemato-oncologist after definitive diagnosis, and commencing chemotherapy as early as possible after surgery, are thought to improve prognosis.     

Surgical treatment of the single non traumatic perforation of small bowel: excision-suture or resection-anastomosis

OBJECTIVE: To evaluate morbidity and mortality following excision-suture and resection-anastomosis for single non traumatic perforations of small bowel (SNTPB). METHODS: From July 2002 to June 2003, a simple blind randomized study comparing excision-suture with resection-anastomosis SNTPB. RESULTS: Of the 125 patients included, 112 were operated by surgeons on training (89.6%). The perforation sat on the antimesenteric edge of the last ileal portion with an average diameter of 0.8 cm (extreme 0.1 and 4 cm). An excision-suture was performed 66 times (52%) including 5 times by an experienced surgeon. 56 patients had simple continuations (45.2%). Morbidity concerned 68 patients (54,8%). 06 patients died of general complications (4.8%). The technique did not influence the mortality. All dead patients were operated by surgeons on training, P=0.25. The complications were significantly more frequent after resection-anastomosis (79.7%) than after excision-suture (32.3%). The difference was significant for the parietal abscesses (P=0,01), the exteriorized fistulas (P=0.04), the septic shocks (P=0.05). CONCLUSION: Whereas mortality was not influenced by the technique, the postoperative course was more complicated after resection-anastomosis (performed in majority by less experienced surgeons). We recommend excision-suture to repair SNTPB.     

胃癌穿孔的外科治疗

目的 探讨胃癌穿孔的外科治疗方法。方法 对1988年1月至1998年1月间74例胃癌穿孔的患所实施的几种手术方式及其疗效进行回顾分析。结果 穿孔修补30例,姑息性切除24例,根治性切除20例。术后并发症发生率6．8％;手术死亡率1．4％。穿孔修补、姑息性切除、根治性切除术后1、3、5年生存率分别为3．3％、0、0;54．2％、25．0％、0;75．0％、55．0％、20．0％。;结论 对于胃癌急性穿孔的病例,采取积极的治疗措施,可望延长患的生存时间和提高患的生存质量。     

Rupture and perforation of urinary reservoirs made from bowel

A review of the literature involving the rupture or perforation of urinary reservoirs made from the bowel indicates that this complication is perhaps not as rare as commonly perceived. It is a severe complication for which a high index of suspicion needs to be maintained. Physicians attending to patients with such urinary reconstructions should be aware that the diagnosis is often difficult to confirm without resorting to exploratory laparotomy and in particular that a negative cystogram can be misleading. A practical suggestion to help alert these physicians to the possibility of a ruptured urinary reconstruction is that such patients should carry a medical card stating the type of reservoir they have along with their special circumstances. From the reported experiences, it is, however, clear that in carefully selected cases and with vigilant monitoring, some patients may be managed non-operatively.     

结肠镜术并发肠穿孔的诊断与处理

结肠镜已成为目前诊治结直肠疾病最常用的方法.尽管肠穿孔与医源性因素及患者某些高危因素有关,发生率较低,但被认为是结肠镜术严重的并发症之一,病死率高.根据结肠镜术中或术后患者的临床表现,早期发现肠穿孔是成功治疗的前提,也是降低病死率的关键.在治疗上有保守治疗、开腹手术、腹腔镜手术及内镜夹等多种方法.临床上应具体分析和准确判断病情,不能一概而论,根据患者的临床表现、穿孔大小、肠道准备情况、确诊时间、结肠原发病变等具体临床条件选择合理有效的治疗方案.     

Inter- and intraindividual variabilities of perforation forces of human and pig bowel tissue

Background: A laparoscopic bowel grasper should be suitable for safely grasping the bowel in a wide variety of patients. Therefore, the inter- and intraindividual variabilities in the strength of bowel tissue to resist perforation force should be analyzed. Methods: The large and small bowels of pigs (n = 14) and the human small bowel (n = 7) were clamped between two hemispheres 1.5 mm in diameter. The pinch force was increased until the tissue was perforated. Results: The perforation force for the pig large bowel was higher than for the small bowel (13.5 ± 3.7 vs 11.0 ± 2.5 N; p = 0.014). No difference was found between the human and pig small bowel (10.3 ± 2.9 vs 11.0 ± 2.5 N). The intercoefficient of variation varied between 22% and 28%, and the intracoefficient of variation varied between 14% and 18%. Conclusions: The strength of the pig bowel is approximately comparable to the strength of the human bowel, and, therefore, testing of graspers on pig bowel is justified. However, due to the large interindividual variation, large safety margins should be taken into account.     

小肠原发性非霍奇金淋巴瘤34例临床分析

目的探讨小肠淋巴瘤的临床特点、治疗和预后。方法对1996年1月至2005年12月间收治的经组织病理学明确诊断、并作免疫学分型的原发性小肠淋巴瘤34例患者的临床资料进行分析。结果27例为B细胞淋巴瘤，7例为T细胞淋巴瘤。腹痛和肠梗阻是主要临床表现。用Ann Arbor分期，22例为Ⅰ～Ⅱ期，其中B细胞淋巴瘤20例（74．1％），T细胞淋巴瘤2例（2／7）；12例为Ⅲ～Ⅳ期，其中B细胞淋巴瘤7例（25．9％），T细胞淋巴瘤5例（5／7）；小肠B细胞淋巴瘤的分期低于T细胞淋巴瘤（P〈0．05）；27例行手术治疗，14例行6次化疗[方案为CHOP（环磷酰胺、阿霉素、长春新碱和强的松龙）]，8例同时加用抗CD20单克隆抗体Rituximab。T细胞淋巴瘤急诊手术率高于B细胞淋巴瘤（P〈0．05），B细胞淋巴瘤更易达到完全缓解（P〈0．05），累计生存率高于T细胞淋巴瘤（P〈0．05）。结论小肠B细胞淋巴瘤Ⅰ和Ⅱ期对手术和化疗效果佳，T细胞淋巴瘤的治疗效果和预后不满意。     

Small bowel obstruction and perforation due to a displaced spiral tacker: a rare complication of laparoscopic inguinal hernia repair

Laparoscopic techniques are now commonly used for the repair of inguinal hernias, since they offer rapid postoperative recovery and low complication rates. These methods usually involve the use of sutures, staples or titanium spiral tackers for safe, secure mesh fixation. We report a rare case of obstruction and perforation of the small bowel resulting from a band adhesion caused by a displaced spiral tacker.     

晚期胃癌合并穿孔的诊断与治疗

目的 探讨胃癌合并穿孔的诊断和治疗方法。方法 对本院28例胃癌合并穿孔患者的资料进行回顾性分析。结果 本组治愈26例，死亡2例，死于中毒性休克并发MODS。手术后并发症十二指肠残端漏1例及上消化道出血2例，均经非手术疗法而治愈。单纯穿孔缝合修补术11例，平均生存时间为4个月；姑息性胃大部切除术9例，平均生存时间为1年；根治性胃大部切除和全胃切除术8例，平均生存时间4年余。结论 胃癌合并穿孔的手术方式有多种，如能掌握其指征和方法均有一定疗效，而根治性的切除能明显提高生存率。     

Laparoscopic wedge resection for gastric perforation after endoscopic mucosal resection: report of a case

We performed laparoscopic wedge resection to treat gastric perforation that occurred as a complication of endoscopic mucosal resection (EMR) in a 53-year-old man. We believe this is an appropriate procedure to treat gastric perforation after EMR for early gastric cancer because it is safe and minimally invasive, and faster recovery can be expected than after conservative therapy. Received: October 31, 2001 / Accepted: March 5, 2002     

结肠癌并发急性穿孔18例诊治体会

目的　探讨结肠癌梗阻并发急性穿孔的处理方法。方法　总结我院近 15年来收治的18例结肠癌急性穿孔病例进行回顾性分析。结果　本组死亡 6例 ,感染性休克、急性肾功能衰竭、呼吸衰竭是主要死因。结论　及时诊断、积极治疗、简捷有效的手术可降低本病的死亡率。病情允许 ,可做一期切除和一定范围的肠段及淋巴结切除 ,术后辅助治疗 ,有望患者得到较长时间的生存。     

Gastric perforation by a foreign body presenting as a pancreatic pseudotumour

INTRODUCTION

Foreign body ingestion rarely causes complications, though it can pose a significant diagnostic challenge. Perforation, particularly of more muscular viscera, can present insidiously with a wide range of differential diagnoses.

PRESENTATION OF CASE

Here we present a case of 75 year-old woman presenting with chest and epigastric pain. Initial imaging suggested a pancreatic lesion. Despite appropriate treatment she deteriorated clinically, and following urgent laparotomy a duck bone fragment was found to have perforated the lesser curvature of the stomach and embedded within the liver causing subhepatic abscess formation and associated inflammation.

DISCUSSION

There are a number of examples of insidious presentations of gastrointestinal perforation. However, we have found only one other case of a perforation presenting as a pancreatic pseudotumour, and ours is the first to have been successfully managed by removal of the foreign body and drainage of the abscess alone.

CONCLUSION

A high level of suspicion is required to make the correct diagnosis in cases such as these where the symptoms are not clear-cut. Thorough review and discussion of imaging prior to surgical treatment is essential to prevent unnecessary intervention.     

Blind loop perforation after side-to-side ileocolonic anastomosis

Blind loop syndrome after side-to-side ileocolonic anas-tomosis is a well-recognized entity even though its in-cidence and complication rates are not clearly defined. The inevitable dilation of the ileal cul-de-sac leads to stasis and bacterial overgrowth which eventually leads to mucosal ulceration and even full-thickness perfora-tion. Blind loop syndrome may be an underestimated complication in the setting of digestive surgery. It should always be taken into account in cases of acute abdomen in patients who previously underwent right hemicolectomy. We herein report 3 patients who were diagnosed with perforative blind loop syndrome a few years after standard right hemicolectomy followed by a side-to-side ileocolonic anastomosis.     

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目的 探讨胃癌穿孔的临床特点,指导临床诊治和提高疗效。方法对本病２７例胃癌穿孔病人采用不同手术方式治疗。其中５例行单纯穿主,２便在孔修补术后３周早期施行二期根治术手术,３例行穿孔修补和胃空肠吻合术。１２例行姑息胃大部切除术,４便行胃癌根治术,１例行胃造口,结果 本组民５例。经手术者平均生存期分别为８个月、１３个月和２７．２个月。结论 早期诊断,综合治疗,是降低病死率提高生存质量的重要因素。