穿孔をきたした小腸悪性リンパ腫の１例

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  • A case of malignant lymphoma causing perforation.

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An 89-year-old man was seen at the hospital because of right lower abdominal pain. Chest plain x-ray film revealed intraabdominal free air image. Abdominal CT scan demonstrated intraabdominal free air image and an isodensity mass about 5cm in diameter in the right lower quadrant of the abdomen. An emergency operation was performed with a diagnosis of perforation of gastrointestinal tumor. At laparotomy, a tumor with perforation at the terminal ileum and a swelling of mesenteric lymph node were present. An excision of the ileocecum was performed. The resected material revealed type II tumor of which bottom of ulcer partially perforated. Histopathologically, it was diagnosed as B-cell type malignant lymphoma, non-Hodikin disease, follicular lymphoma medium size cell type according to the Lymphoma Study Group Classification. Postoperative course was uneventful and the patient could recover from peritonitis. About 2 months later when it was close to the time of discharge, the patient abruptly presented cancerous lymphangitis like chest findings and died.<br> Although no chemotherapy was given to the patient because of his advanced age, some chemotherapy had to be performed because the tumor was in stage I at a postoperative general exploration. This is a case asking us to reconsider.

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