title: [Perforation in the primary T-cell lymphoma of the small intestine due to effective chemotherapy-a case report].
abstract: A 71-year-old man presented at a clinic with fever and melena. Capsule endoscopy revealed ulcers accompanied by bleeding in the central part of the jejunum. Blood tests revealed a high level of soluble interleukin-2 receptor( sIL-2R). A malignant lymphoma of the small intestine was suspected. A biopsy was performed using double-balloon enteroscopy. We diagnosed a malignant lymphoma, peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS). There was a large amount of ascites and we determined that it was stage IIE according to the Lugano International Conference classification. The patient was hospitalized to receive pirarubicin hydrochloride, cyclophosphamide, vincristine sulfate, and prednisolone (THP-COP) therapy. One day after the fourth chemotherapy cycle, the patient complained of abdominal pain. Perforative peritonitis was diagnosed by abdominal computed tomography and emergency laparotomy was performed. A 3.5×2.0 cm perforation was detected in the jejunum, 180 cm from the ligament of Treitz. Approximately 20 cm of the small intestine was resected, and functional end-to-end anastomosis was performed. Histology showed that there were no malignant cells around the perforation site. We believe that the malignant lymphoma had disappeared rapidly because of the effective chemotherapy, and fibrosis could not adequately cover the space from which the tumor had disappeared. Although pancytopenia was observed and granulocyte colony-stimulating factor (G-CSF) was administered to the patient, the postoperative course was uneventful. He received the fifth course of chemotherapy on postoperative day 21.
authors.affiliation: Dept. of Surgery, Sakai City Hospital.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ebihara
authors.forename: Ken
authors.initials: K
authors.lastname: Nakata
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Fukunaga
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ohzato
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001706:Biopsy; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology* / Q000601:surgery; D007580:Jejunal Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D016411:Lymphoma, T-Cell, Peripheral / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D008297:Male