INTRODUCTION: Primary colonic lymphoma is rare. It comprises less than 1% of large bowel malignancies. Affected patients often present with non-specific vague symptoms with subsequent delays in diagnosis and management. PRESENTATION OF CASE: An immuno-competent 35-year-old male presented with left iliac fossa pain, fever and constipation. Clinical examination revealed left-sided abdominal peritonism. After the initial radiological and endoscopic investigations, a provisional diagnosis of a localized perforation of a splenic flexure diverticulum was made and ultrasound-guided percutaneous drainage of the abscess was performed. The patient failed to settle on conservative treatment and therefore exploratory laparotomy was carried out. An inflammatory phlegmon consisting of a left paracolic gutter abscess, the spleen and the splenic flexure of the colon was resected en-bloc and a primary colo-colic anastomosis was performed. His operative recovery was complicated by wound infection which was treated conservatively. The histopathology revealed colo-splenic fistula secondary to a perforated colonic non-Hodgkin's lymphoma. The spleen contained multiple metastatic lymphomatous deposits. He was started on chemotherapy and remained well at 5-year follow up. DISCUSSION: Colon non-Hodgkin's lymphoma may present initially with an acute abdomen due to perforation. It mimics any acute surgical condition. Perforation and fistulaization into the spleen is very rare. CONCLUSION: This case highlights the delay and difficulty in diagnosing primary colonic lymphoma without resorting to surgical resection.
INTRODUCTION:Primary colonic lymphoma is rare. It comprises less than 1% of large bowel malignancies. Affected patients often present with non-specific vague symptoms with subsequent delays in diagnosis and management. PRESENTATION OF CASE: An immuno-competent 35-year-old male presented with left iliac fossa pain, fever and constipation. Clinical examination revealed left-sided abdominal peritonism. After the initial radiological and endoscopic investigations, a provisional diagnosis of a localized perforation of a splenic flexure diverticulum was made and ultrasound-guided percutaneous drainage of the abscess was performed. The patient failed to settle on conservative treatment and therefore exploratory laparotomy was carried out. An inflammatory phlegmon consisting of a left paracolic gutter abscess, the spleen and the splenic flexure of the colon was resected en-bloc and a primary colo-colic anastomosis was performed. His operative recovery was complicated by wound infection which was treated conservatively. The histopathology revealed colo-splenic fistula secondary to a perforated colonic non-Hodgkin's lymphoma. The spleen contained multiple metastatic lymphomatous deposits. He was started on chemotherapy and remained well at 5-year follow up. DISCUSSION: Colon non-Hodgkin's lymphoma may present initially with an acute abdomen due to perforation. It mimics any acute surgical condition. Perforation and fistulaization into the spleen is very rare. CONCLUSION: This case highlights the delay and difficulty in diagnosing primary colonic lymphoma without resorting to surgical resection.
Authors: P Koch; F del Valle; W E Berdel; N A Willich; B Reers; W Hiddemann; B Grothaus-Pinke; G Reinartz; J Brockmann; A Temmesfeld; R Schmitz; C Rübe; A Probst; G Jaenke; H Bodenstein; A Junker; C Pott; J Schultze; A Heinecke; R Parwaresch; M Tiemann Journal: J Clin Oncol Date: 2001-09-15 Impact factor: 44.544