A Case of Ileocolic Penetration due to Recurrence of Malignant Lymphoma Accompanied by Secondary Hypogammaglobulinemia

Abstract

A 60-year-old man had repeated remissions and relapses with multiple chemotherapy courses due to follicular lymphoma since the age of 45 years. He had secondary gammaglobulinemia due to the repeated chemotherapy and was receiving an intravenous infusion of gammaglobulin regularly. Computed tomography demonstrated wall thickening of the terminal ileum and ileocecal lymphadenopathy, and colonoscopy showed stenosis of the ascending colon. The diagnosis of recurrent malignant lymphoma was made, and chemotherapy was performed. Nineteen days after the chemotherapy, the patient experienced abdominal pain and was diagnosed with an ileocolic fistula and lower gastrointestinal penetration. Preoperative administration of antibacterial drug therapy and additional administration of gammaglobulin preparation was followed by right hemicolectomy. Postoperative administration of antibacterial drug therapy and the gammaglobulin preparation was continued. He recovered without any postoperative complications and was discharged from hospital. Perioperative management with administration of appropriate antibacterial drug therapy and a gammaglobulin preparation to patients with hypogammaglobulinemia would be helpful.