Hydronephrosis presenting as the first sign of malignant lymphoma of the small intestine: report of a case

A 45-year-old man was admitted to hospital on November 26, 1985 with the chief complaint of left hypochondrial pain. Excretory and retrograde pyelography revealed left hydronephrosis due to extrinsic obstruction of ureter. Computerized tomography and angiography revealed that a tumor of the small intestine was the cause of ureteral obstruction. In addition to the presence of a tumor, a fistula in the small intestine was disclosed on the upper gastrointestinal series. During the operation, a large mass which involved several organs was identified without mobility. The sophisticated operation was composed of wide resection of small intestine including the tumor, left hemicolectomy, left nephroureterectomy, splenectomy, partial pancreatectomy, duodeno-ileostomy and transverse sigmoidostomy was done on December 19, 1985. Pathological diagnosis was malignant lymphoma, diffuse small cell type infiltrating ureter, kidney and perirenal connective tissue. Because of poor postoperative course systemic chemotherapy was not performed and he died of disseminated intravascular coagulation on April 2, 1986.