Pancreaticoduodenectomy for Perforated Gastric Malignant Lymphoma: Report of a Case

Abstract

We herein report the case of a 65-year old man with gastroduodenal malignant lymphoma (diffuse large B-cell type) accompanied with a bulbar perforation. A pancreaticoduodenectomy was performed because the duodenal second portion and pancreatic head were involved. However, extensive lymphadenectomy was not carried out because many lymph nodes were involved. The postoperative course was uneventful and CHOP therapy (pirarubicin 30 mg/m2, cyclophosphamide 500 mg/m2, vincristine 1 mg/m2, prednisolone 30 mg/m2) was started 1 month after surgery. Seven cycles of CHOP therapy markedly reduced the residual lesions including lymph nodes, and a computed tomography scan after the final chemotherapy revealed no obvious lesions. Complete remission was obtained and the patient was discharged 9 months after surgery.

Successful Use of a Multidisciplinary Approach to Treat a Perforated Duodenal Malignant Lymphoma in an Elderly Patient

“…Gastrointestinal perforation due to lymphoma may extend into sepsis and/or peritoneal dissemination of disease, resulting in a poor outcome and a mortality rate of about 60% [ 3 , 9 ]. A literature survey revealed reports of four cases of perforated duodenal lymphoma in Japan through 1980–2017 (written in Japanese without English abstracts [ 22 – 25 ]). The clinical characteristics of these four cases plus our own are summarized in Table 1 .…”

Urgent Multivisceral Resection due to Perforated Primary Gastric Lymphoma

“…The postoperative course was uneventful and chemotherapy was effective in eliminating the involved lymph nodes. Authors concluded, that the choice of surgical resection is very important in patients with perforated gastric lymphoma, since chemotherapy should be started as soon as possible after surgery [4].…”

“…A spontaneous perforation has been reported from 1% to 5% of cases of primary gastric lymphoma and commonly occurs after chemotherapy and irradiation [3]. Emergency surgery is usually performed but the prognosis in cases of perforated gastrointestinal lymphoma is very poor [4]. This report describes a case of a young man with spontaneous perforation of primary gastric malignant lymphoma and diffuse peritonitis without prior chemotherapy.…”