A Case of Malignant Lymphoma of the Jejunum Presented with Perforated Peritonitis

We report a rare case of primary malignant lymphoma of the jejunum presented with perforated peritonitis. A 73-year-old man was adrnitted to our hospital because of a sudden onset of severe upper abdominal pain . Plain chest and abdominal X-ray films revealed free air in the bilateral subphrenic areas. An emergency laparotomy was performed under a diagnosis of perforated peritonitis. At the laparotomy, an infant's fist -sized tumorous lesion with perforation was found at about 70 cm distant from the duodeno-jejunal junction. A partial resection of the jejunum, about 30 cm in length, dissection of enlarged mesenteric lymph nodes and drainage were performed. Intraoperative diagnosis was panperitonitis due to perforated jejunal tumor. Histopathological examination demonstrated a malignant lymphoma of diffuse and small cell type by LSG classification. Proliferation of similar lymphoma cells was observed in mesenteric lymph nodes. Postoperative chemotherapy was unsuccessful and about 10 months after the operation, the patient died due to peritoneal dissemination. In perforated cases, maligmant lymphoma of the small intestine has been reported to have a poor prognosis. Adequate selection of therapeutic methods and careful observation of clinical course are necessary.

空調原発悪性リンパ腫

穿孔性腹膜炎