A case of primary gastrointestinal lymphoma presenting as colonic perforation

Introduction: Non-Hodgkin lymphoma represents 0.3% of colonic malignancies. It presents in older males with comorbid infection, autoimmune disease or immunosuppression. Presenting symptoms are often non-specific including abdominal pain, decreased appetite, weight loss and anemia. Colonic perforation or obstruction from primary colonic lymphoma is commonly reported after treatment with chemotherapeutic agents. We present a rare case of primary gastrointestinal lymphoma presenting with perforation of the descending colon causing retroperitoneal abscess formation. Case Report: A 65-year-old, hepatitis C virus positive, white male presented to primary care with chronic abdominal pain and forty pound weight loss. Computed tomography of the abdomen showed a locally invasive mass arising from the descending colon and extending into both the perirenal space and abdominal wall with evidence of contained colonic rupture. One week later, the patient presented to the hospital with Jeffrey P. Fleming1, Katie Smith1, Robert Bennett2, Gino F. Piparo3, Andrew Taitano4 Affiliations: 1BS, Medical Student, College of Medicine, University of Central Florida, Orlando, FL, USA; 2MD, Chief Resident, Department of General Surgery, University of South Florida College of Medicine, Tampa, FL, USA; 3MD, Attending Physician, Department of Pathology, Bay Pines VA Healthcare System, Bay Pines, FL, USA; 4MD, Attending Physician, Department of Surgery, Bay Pines VA Healthcare System, Bay Pines, FL, USA. Corresponding Author: J. Paul Fleming, BS, Bay Pines VAHCS, Department of Surgery, 10000 Bay Pines Blvd, Bay Pines, FL 33744; Email: [email protected] Received: 10 March 2017 Accepted: 09 May 2017 Published: 23 June 2017 sepsis. Emergent exploratory laparotomy was performed with removal of the affected colonic section and debridement of the retroperitoneal abscess to control the sepsis source. Surgical specimen pathologic analysis revealed primary diffuse large B cell lymphoma of the colon. The patient was discharged home in stable condition with scheduled outpatient oncologic treatment. Conclusion: Lymphoma should be considered in older men with a history of immunosuppression and viral infections such as HCV presenting with signs and symptoms of colon cancer. We emphasize that colonic perforation is a rare, yet important, initial presentation of primary colonic non-Hodgkin lymphoma. Surgical intervention is the primary treatment in this scenario to control bacteremia and sepsis, as seen in our patient.