Journal of

Case Reports and Images in Surgery

 
     
Case Report
 
A case of primary gastrointestinal lymphoma presenting as colonic perforation
Jeffrey P. Fleming1, Katie Smith1, Robert Bennett2, Gino F. Piparo3, Andrew Taitano4
1BS, Medical Student, College of Medicine, University of Central Florida, Orlando, FL, USA
2MD, Chief Resident, Department of General Surgery, University of South Florida College of Medicine, Tampa, FL, USA
3MD, Attending Physician, Department of Pathology, Bay Pines VA Healthcare System, Bay Pines, FL, USA
4MD, Attending Physician, Department of Surgery, Bay Pines VA Healthcare System, Bay Pines, FL, USA

Article ID: 100043Z12JF2017
doi:10.5348/Z12-2017-43-CR-8

Address correspondence to:
J. Paul Fleming
BS, Bay Pines VAHCS, Department of Surgery
10000 Bay Pines Blvd,
Bay Pines, FL 33744

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How to cite this article:
Fleming JP, Smith K, Bennett R, Piparo GF, Taitano A. A case of primary gastrointestinal lymphoma presenting as colonic perforation. J Case Rep Images Surg 2017;3:29–34.


ABSTRACT

Introduction: Non-Hodgkin lymphoma represents 0.3% of colonic malignancies. It presents in older males with comorbid infection, autoimmune disease or immunosuppression. Presenting symptoms are often non-specific including abdominal pain, decreased appetite, weight loss and anemia. Colonic perforation or obstruction from primary colonic lymphoma is commonly reported after treatment with chemotherapeutic agents. We present a rare case of primary gastrointestinal lymphoma presenting with perforation of the descending colon causing retroperitoneal abscess formation.
Case Report: A 65-year-old, hepatitis C virus positive, white male presented to primary care with chronic abdominal pain and forty pound weight loss. Computed tomography of the abdomen showed a locally invasive mass arising from the descending colon and extending into both the perirenal space and abdominal wall with evidence of contained colonic rupture. One week later, the patient presented to the hospital with sepsis. Emergent exploratory laparotomy was performed with removal of the affected colonic section and debridement of the retroperitoneal abscess to control the sepsis source. Surgical specimen pathologic analysis revealed primary diffuse large B cell lymphoma of the colon. The patient was discharged home in stable condition with scheduled outpatient oncologic treatment.
Conclusion: Lymphoma should be considered in older men with a history of immunosuppression and viral infections such as HCV presenting with signs and symptoms of colon cancer. We emphasize that colonic perforation is a rare, yet important, initial presentation of primary colonic non-Hodgkin lymphoma. Surgical intervention is the primary treatment in this scenario to control bacteremia and sepsis, as seen in our patient.


Keywords: Colonic perforation, Diffuse large B cell lymphoma, Gastrointestinal lymphoma



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Author Contributions
Jeffrey P. Fleming - Substantial contributions to conception and design, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Katie Smith – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Robert Bennett – Substantial contributions to conception and design, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Gino F. Piparo – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Andrew Taitano – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2017 Jeffrey P. Fleming et al. This article is distributed of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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