A 47-year old male had constipation and rectal bleeding for 1 months. Sigmoidoscopic biopsy of the rectal mass was performed, and histologic diagnosis was malignant lymphoma, diffuse, large cell type. Abdominoperineal resection was done with
curative
intent, and postoperative adjuvant radiotherapy was done as 6,000 rads 4 weeks.
One year and 5 moths after the miles' operation, he had jaundice, epigastric pain and mass. Diagnostic work up revealed a tumor mass of the duodenum, probably a metastatic or metachronous duodenal lymphoma. At laparotomy, the duodenum were
entirely
replaced with tumor and multiple perforation due to tumor necrosis were noted after the adhesiolysis of the omentum from the tumor the tumor directly extended to the right kidney and mesocolon of the transverse colon. Paraaortic lymph nodes were
not
palpable and there was no evidence of tumor in the pelvic cavity.
Palliative whipple resection with right nephrectomy and transverse colectomy was done. After the operation, minor leakage from the hepaticojejunostomy and gastrojejunostomy sites was noted but spontaneous closure was noted. Despite TPN and sump
suction,
his general condition was deteriorated and he was succumbed to death due to sepsis.
Althought surgical resection and postoperative adjuvant radiotherapy can accomplish local control of the primary intestinal lymphoma, recurrence outside the treatment field is common Therefore, systemic multidrug combined chemotherapy should be
added to
resection and radiotherapy.
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