Abstract
A 75-year-old woman was brought into our ER by ambulance complaining of the sudden onset of lower abdominal pain. Physical examination showed abdominal muscle guarding with rebound tenderness. An abdominal CT scan revealed an infant's head-sized tumor with irregular wall thickening at the proximal jejunum, associated with free air and ascites around the liver. She was diagnosed as having a perforated jejunal tumor, and underwent emergency operation. Laparotomy showed an infant's head-sized tumor with huge perforation at the proximal jejunum, which involved SMA and the distal duodenum. The tumor was removed by resecting the proximal jejunum using Echelon 60 and intestinal continuity was maintained by side-to-side duodenojejunostomy. The histological diagnosis was primary T-cell malignant lymphoma of the small intestine. The residual tumor showed rapid growth after the operation, and she died 56 days after the operation. Not only early detection of intestinal symptoms but also early diagnosis with PET or small bowel endoscopy before perforation is likely to improve clinical course of primary T-cell malignant lymphoma of the small intestine.
