Spontaneous gastrointestinal perforation in patients with lymphoma receiving chemotherapy and steroids. Report of three cases.

Wada, Miki; Onda, Masahiko; Tokunaga, Akira; Kiyama, Teruo; Yoshiyuki, Toshiro; Matsukura, Norio; Furukawa, Kiyonori; Egami, Kaku; Yamashita, Kiyohiko

doi:10.1272/jnms.66.37

Cited by 33 publications

(24 citation statements)

References 14 publications

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“…18 According to Wada et al, the most common factor attributing to bowel perforation in patients with malignant lymphoma is the use of systemic chemotherapy and steroids which induces tumor necrosis in the intestine. 11 Systemic chemotherapy with steroids had been given to our case 1; however, instead of any intensive necrosis around the perforation site, we found ulceration surrounded by lymphoma cells. We believe that the bowel perforation in case 1 occurred following the infiltration of lymphoma cells into the bowel wall through the lymphatic vessels.…”

Section: Discussionmentioning

confidence: 60%

Small Bowel Perforation Caused by Metastasis from an Extra-Abdominal Malignancy: Report of Three Cases

Ise¹,

Kotanagi²,

Morii³

et al. 2001

Surgery Today

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Small bowel perforation is rarely caused by metastasis from an extra-abdominal malignancy. This report describes three cases of small bowel perforation that occurred secondary to a metastatic tumor. The first case involved a 72-year-old man with malignant lymphoma of the larynx that had been treated with chemo- and radiation therapy; the second involved a 70-year-old man with rhabdomyosarcoma of the mediastinum that had been treated with radiation therapy; and the third involved a 41-year-old man with lung carcinoma that had been treated with surgery 10 months prior to perforation. Each patient presented with acute abdominal pain, had X-ray findings of free air in the abdomen, and underwent limited emergency surgery. Wedge resection and closure of the ileum was performed for the first patient and partial bowel resection with the creation of an intestinal stoma was performed for the second and third patients. In each case, the histologic findings of the resected specimens were consistent with the extra-abdominal primary tumors. Although the patients recovered sufficiently to begin eating and moving about, all three died of cancer or cancer-related complications within 45 days of surgery. We conclude that surgeons should be aware of the poor prognosis of such patients and perform only the minimal surgery required.

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Section: Discussionmentioning

confidence: 60%

Small Bowel Perforation Caused by Metastasis from an Extra-Abdominal Malignancy: Report of Three Cases

Ise¹,

Kotanagi²,

Morii³

et al. 2001

Surgery Today

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show abstract

“…These included perforations from the lymphoma itself as well as from treatment-related complications such as neutropenic colitis, infectious colitis, radiation enteritis and colonic pseudoobstruction. Other small series of perforation events in GI lymphoma also report a range of time to perforation from 4 days to >5 weeks from the initiation of chemotherapy [8][9][10]. We hypothesize that tumor necrosis and inflammation after administration of chemotherapy contribute to these later perforation events.…”

Section: Morbidity and Mortalitymentioning

confidence: 75%

Bowel perforation in intestinal lymphoma: incidence and clinical features

Vaidya¹,

Habermann²,

Donohue³

et al. 2013

Annals of Oncology

126

143

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Background: Perforation is a serious life-threatening complication of lymphomas involving the gastrointestinal (GI) tract.Although some perforations occur as the initial presentation of GI lymphoma, others occur after initiation of chemotherapy. To define the location and timing of perforation, a single-center study was carried out of all patients with GI lymphoma. Patients and methods:Between 1975 and 2012, 1062 patients were identified with biopsy-proven GI involvement with lymphoma. A retrospective chart review was undertaken to identify patients with gut perforation and to determine their clinicopathologic features.Results: Nine percent (92 of 1062) of patients developed a perforation, of which 55% (51 of 92) occurred after chemotherapy. The median day of perforation after initiation of chemotherapy was 46 days (mean, 83 days; range, 2-298) and 44% of perforations occurred within the first 4 weeks of treatment. Diffuse large B-cell lymphoma (DLBCL) was the most common lymphoma associated with perforation (59%, 55 of 92). Compared with indolent B-cell lymphomas, the risk of perforation was higher with aggressive B-cell lymphomas (hazard ratio, HR = 6.31, P < 0.0001) or T-cell/other types (HR = 12.40, P < 0.0001). The small intestine was the most common site of perforation (59%). Conclusion:Perforation remains a significant complication of GI lymphomas and is more frequently associated with aggressive than indolent lymphomas. Supported in part by University of Iowa/Mayo Clinic SPORE CA97274 and the Predolin Foundation.

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“…4, 6, and 7). Surgical treatment for small intestinal and colon lymphoma for localized lesions is resection of the affected segment and mesentery and primary anastomosis [6,10,23,24]. For synchronous lymphoma, curative resection may not be performed effectively.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Intestinal Perforation Due to Non-Hodgkin's Lymphoma: Evaluation of Eight Cases

et al. 2007

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Primary intestinal lymphoma with spontaneous perforation and after systemic chemotherapy is rare. The present study summarizes retrospectively the outcome of eight free intestinal perforated patients diagnosed with intestinal non-Hodgkin's lymphoma. Two patients had a history of systemic chemotherapy before perforation. The most common symptoms of the patients were abdominal pain, nausea, vomiting, weight loss, and fever. Sites of perforation were ileum in four, jejunum in two, cecum in one, and sigmoid colon in one patient. Synchronous lymphoma was present in three patients. The perforation was closed by primary closure in three patients. Resection/anastomosis was performed in four patients and sigmoid colostomy was performed in one patient. Three patients were lost due to leakage or septicemia. Intestinal lymphoma might be kept in mind as a cause in free intestinal perforations. Because of the high mortality rate early diagnosis and treatment are important to improve the prognosis of bowel perforation in patients with non-Hodgkin's lymphoma.

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Spontaneous gastrointestinal perforation in patients with lymphoma receiving chemotherapy and steroids. Report of three cases.

Cited by 33 publications

References 14 publications

Small Bowel Perforation Caused by Metastasis from an Extra-Abdominal Malignancy: Report of Three Cases

Small Bowel Perforation Caused by Metastasis from an Extra-Abdominal Malignancy: Report of Three Cases

Bowel perforation in intestinal lymphoma: incidence and clinical features

Spontaneous Intestinal Perforation Due to Non-Hodgkin's Lymphoma: Evaluation of Eight Cases

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