Primary Intestinal Burkitt Lymphoma with Perforating Peritonitis during Chemotherapy

Abstract

A 66-year-old man admitted to a hospital with abdominal distention and bloody stools was found having a lesion with remarkable wall thickening in the ileocecal region on CT. Following a colonoscopy and a biopsy, the diagnosis of primary intestinal Burkitt lymphoma in Stage II2 (Lugano classification for staging of lymphomas) was made. He was referred to the Department of Hematological Medicine in our hospital R-EPOCH therapy was performed, but small bowel obstruction developed after the end of 4 courses. Decompression treatment using an ileus tube gave a temporary improvement, however, he developed an abrupt onset of right lower abdominal pain. Further CT scan revealed ascites and free air around the ileocecal area, suggesting perforating peritonitis that required surgical intervention. We performed an emergency operation with the diagnosis of perforating peritonitis. The chemotherapy was resumed on postoperative-day 43. The postoperative course then proceeded uneventfully, and he remains currently under observation. Gastrointestinal malignant lymphoma is sometimes reported in cases requiring emergency surgery involving intussusception, bowel obstruction, gastrointestinal perforation, and others. Information sharing between internal-medicine and surgery is recommended, by keeping a possible need for emergency surgery in mind.