Perforation of bowel lymphoma: beware of atypical presentations.
BACKGROUND
Intestinal lymphomas can present as surgical complications such as perforation. There is little data regarding the risk factors, clinical features, management, and prognosis of bowel perforation in patients with intestinal lymphoma. The aims of this study were to analyze the risk factors for this complication and to describe the clinical picture.


METHODS
All patients undergoing surgery for lymphoma-related perforation between 2002 and 2012 in the University Hospital of Dijon were retrospectively analyzed. The clinical, histological, and imaging features were recorded.


RESULTS
Six patients underwent emergent laparotomy for this cause: in three patients, the perforation revealed the underlying disease, and in the other three patients, it occurred during chemotherapy treatment for known lymphoma. The clinical picture was a typical acute peritonitis in the first group, but was nonspecific and insidious in the chemotherapy-induced group. In all cases, aggressive lymphomas were present, and three patients had coexisting infection with the human immunodeficiency virus.


CONCLUSIONS
Lymphoma-related perforation presents as an acute peritonitis in previously untreated patients in which it reveals the disease. However, it may be induced by chemotherapy and present with nonspecific insidious symptoms. The prognosis is also different according to these characteristics. The particularities of this disease warrant its knowledge to ensure an optimal management.
Service de Chirurgie Digestive et Cancérologique, CHU Bocage Central, 14, rue Gaffarel, 21079, Dijon, France.
Nicolas
N
Lagoutte
Alexandre
A
Doussot
Universe
U
Leung
Olivier
O
Facy
Jean Noël
JN
Bastie
Patrick
P
Rat
Pablo
P
Ortega-Deballon
D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology*; D008223:Lymphoma / Q000150:complications* / Q000628:therapy; D011379:Prognosis; D012307:Risk Factors