胃穿孔および小腸閉塞で発症した悪性リンパ腫の１例

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  • A CASE OF MALIGNANT LYMPHOMA WITH GASTRIC PERFORATION AND INTESTINAL OBSTRUCTION

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We report a rare case of primary gastric lymphoma with spontaneous perforation and intestinal obstruction.<br> A 65-year-old woman complained of frequent bouts of diarrhea and constipation was admitted to our hospital and diagnosed as having intestinal obstruction. Abdominal computed tomography showed bilateral subphrenic free air, marked dilated intestine and several low density areas in the spleen. Intestinal obstruction due to a malignant tumor with gastro-intestinal perforation was suspected and an emergency operation was performed. There were a white and hard tumor 2cm in diameter in the small intestine, perforation in the anterior wall of upper portion of the stomach, and multiple splenic tumors. Intraoperative diagnosis was made as gastric perforation dut to the malignant tumor with metastases to the spleen and small intestine. Total gastrectomy with distal pancreatosplenectomy with lymph nodes dissection was performed. Pathohistological diagnosis was malignant lymphoma of the stomach, diffuse medium-sized B cell type. She was made CHOP therapy but died of MRSA colitis 2 months after the operation. Malignant lymphoma of the stomach rarely causes spontaneous gastric perforation, and no cases of its metastasis to the small intestine with intestinal obstruction have been reported. Accordingly this case is reported together with some bibliographical comments.

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