SummaryMalignant gastric lymphoma, accounting only for 1% of primary gastric carcinoma, is usually a diffuse large B-cell lymphoma. Toyota et al reported that 37% of gastric perforations involved malignancy, generally gastric carcinoma. Fukuda et al found that less than 5% of malignant gastric lymphomas perforate. While it is relatively well known that perforations often take place during chemotherapy, they are rare in patients not receiving chemotherapy. To our knowledge, spontaneous perforation is rare in gastric malignant lymphoma, having been reported in the Japanese literature only 26 times, including this case, in the last 25 years. BACKGROUND

Primary bile duct closure with retrograde transhepatic biliary drainage (RTBD) using an RTBD tube (RTBDT) is a feasible surgical technique after common bile duct exploration in choledocholithiasis in comparison to conventional T-tube insertion. But, unfortunately, this technique is not popular because of the difficulty to introduce a catheter into a proposed intrahepatic bile duct branch without hepatic injury. In addition, the time for its safe removal is not shorter than that with T-tube insertion. So, we have devised a special needle-attached RTBDT (n-RTBDT) to guide the tube via the intrahepatic bile duct of the liver with minimal hepatic injury, and proposed a new surgical technique, namely extraperitoneal RTBD (Ep-RTBD), using the n-RTBDT providing earlier removal without fistula formation in the general peritoneal cavity. In all patients with common bile duct calculi who underwent this surgical procedure, the tube could be revoved within 10 postoperative days with no complication.

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