부산대학교 도서관

We report herein on a case of a malignant lymphoma in the small intestine discovered accidentally after intestinal perforation; the lymphoma was treated with laparoscopic resection. The patient was an 82-year-old woman who was transported by ambulance to the emergency outpatient department of this hospital with abdominal pain. At initial examination, the patient presented with peritoneal irritation signs, including rebound tenderness in the lower right quadrant. A CT scan revealed thickening of the small intestine walls within the pelvis and free air in the surrounding area; therefore, she was diagnosed as having panperitonitis caused by a small intestine perforation and underwent emergency surgery. When the abdominal cavity was examined with laparoscopic assistance, a tumorous lesion was detected with purulent ascites and perforation of the ileum in her lower abdomen. After a mini-laparotomy, partial ileectomy and intraperitoneal drainage were performed. The pathological diagnosis was a small intestinal lymphoma (diffuse large B cell lymphoma). In cases of peritonitis where the causative site of the gastrointestinal perforation cannot be identified, it is useful to conduct an exploratory laparotomy and select an appropriate surgical procedure. Perforation caused by a malignant lymphoma in the small intestine is rare and difficult to diagnose preoperatively, but it is essential to consider this condition as a possible cause of gastrointestinal perforation.