Malignant lymphomas of the small intestine commonly occur in the ileum and most of them are derived from B cells. Recently we experienced a case of T-cell lymphoma of the jejunum with perforation which demanded an emergency laparotomy.
A 73-year-old woman was admitted to another hospital because of abdominal pain, nausea and diarrhea. With close examination, the patient was diagnosed as having a tumor of the small intestine and elective surgery was scheduled, when severe upper abdominal pain occurred. Tenderness, Blumberg's sign and defense of muscle of upper abdomen were present. On abdominal CT scan, perforative peritonitis was diagnosed and the patient was referred to the hospital. Upon laparotomy, a tumor with small perforation was placed in the jejunum about 30cm distant from the Treitz ligament and a partial resection of the jejunum was carried out. Histological diagnosis was malignant lymphoma of the small intestine in stage III, intestine T-cell lymphoma. Postoperatively no lesion was detected in the other organs. Two months after the operation, a left axillary lymph node swelling was noticed and resected. Histological diagnosis showed that the lymph node swelling was the recurrence of malignant lymphoma. CHOP regimen was added in vain and the EHOC regimen and local injection of bleomycin were started. The lymph node swelling is decreased in size. Malignant lymphola is considered as a cause of the perforation of the small intestine.