Intestinal lymphoma--a review of the management of emergency presentations to the general surgeon.
BACKGROUND
Intestinal non-Hodgkin's lymphoma (NHL) is uncommon but not rare. This paper aims to review the recent evidence for the management of perforated NHL of the intestine, consider when chemotherapy should be commenced and examine the likely outcomes and prognosis for patients presenting as surgical emergencies with this condition.


METHODS
MEDLINE and Cochrane databases were searched using intestinal lymphoma, clinical presentation, perforation, management and prognosis. The full text of relevant articles was retrieved and reference lists checked for additional articles.


RESULTS
Emergency surgery was required at disease presentation for between 11 and 64% of intestinal NHL cases. Perforation occurs in 1-25% of cases, and also occurs whilst on chemotherapy for NHL. Intestinal bleeding occurs in 2-22% of cases. Obstruction occurs more commonly in small bowel (5-39%) than large bowel NHL and intussusceptions occur in up to 46%. Prognosis is generally poor, especially for T cell lymphomas.


CONCLUSIONS
There is a lack of quality evidence for the elective and emergency treatment of NHL involving the small and large intestine. There is a lack of information regarding the impact an emergency presentation has on the timing of postoperative chemotherapy and overall prognosis. It is proposed that in order to develop evidence-based treatment protocols, there should be an intestinal NHL registry.
Department of Colorectal Surgery, New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, WV10 0QP, UK, sianabbott@hotmail.com.
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Abbott
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Nikolousis
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Badger
D017558:Elective Surgical Procedures; D004638:Emergency Treatment; D019317:Evidence-Based Medicine; D006801:Humans; D007414:Intestinal Neoplasms / Q000601:surgery*; D008228:Lymphoma, Non-Hodgkin / Q000601:surgery*; D066231:Surgeons