INTESTINAL PERFORATION IN A CASE OF NON-HODGKINS LYMPHOMA

Abstract

Non-Hodgkin's lymphoma patients may experience the rare but serious complication of intestinal perforation. This case report explores a patient who developed a distal ileal perforation following chemotherapy for diffuse large B-cell lymphoma. A 68-year-old male with NHL, initially diagnosed in October 2023, received six cycles of R-CHOP chemotherapy. Post-treatment imaging showed no significant disease activity. However, a repeat PET CT in January 2024 revealed metabolically active wall thickening in the distal ileal bowel loops, suggesting inflammatory or lymphomatous involvement. In March 2024, the patient presented with acute abdominal pain, vomiting, and an inability to pass stools and flatus. Clinical examination indicated peritonitis. Imaging confirmed a perforation of the distal ileum with frank pneumoperitoneum. Emergency exploratory laparotomy was performed, revealing a 3x2 cm perforation at the antimesenteric border of the distal ileum, along with a mesenteric tear and fecal contamination. A double-barrel ileostomy was performed to address the perforation. This case highlights the severe complication of gastrointestinal perforation in NHL patients, emphasizing the importance of early detection and prompt surgical intervention. Vigilant monitoring for gastrointestinal symptoms in NHL patients undergoing chemotherapy is crucial to ensure timely diagnosis and treatment.