A case of precursor B-cell lymphoblastic leukemia with duodenal perforation during induction therapy

Abstract

We present a case of duodenal perforation during induction therapy for acute lymphoblastic leukemia (ALL) recovered by conservative treatment without surgery. A 3-year-old boy with repeated infection and leucopenia was diagnosed with precursor B-cell ALL. On day 26 he had severe abdominal pain and fever. We suspended chemotherapy and started to administer antibiotics and H₂ receptor antagonist. The abdominal CT scan on day 28 showed free gas and perforation in the duodenal bulb, so we diagnosed duodenal perforation. As we observed no worsening of symptoms nor any progression of peritonitis, we continued conservative treatment such as nothing per os, intravenous drip, nasogastric tube detainment, proton pump inhibitor and antibiotics. His symptoms were alleviated. No surgical treatment was performed. After that, complete remission was maintained without recurrence of ulcer and perforation. Gastrointestinal perforation during chemotherapy is a severely adverse event, so prophylactic supportive therapy should be considered if abdominal symptoms persist.