NARBIGE DUNNDARMSTENOSE NACH CHEMOTHERAPIE EINES GASTROINTESTINALEN LYMPHOMS

HISTORY AND CLINICAL FINDINGS: 4 weeks after completing a course of chemotherapy for non-Hodgkin lymphoma of the jejunum a 45-year-old woman developed pain in the left upper abdomen and postprandial vomiting so that she could no longer take food by mouth. INVESTIGATIONS: On admission she looked cachectic and had obviously lost weight. Plain abdominal X-ray gave no evidence of perforation or ileus. Gastroduodenoscopy showed no local recurrence. But contrast jejunal radiography (after Sellink) demonstrated two severe band-like stenoses of the jejunum with prestenotic dilatation. As she had not had any previous operation or radiotherapy, cicatricial stenosis was considered as the most likely cause. As the symptoms continued and stenosing local recurrence could not be excluded, surgical resection was indicated. TREATMENT AND COURSE: Two cicatricial intramural stenoses of the proximal jejunum were found and histologically confirmed without evidence of lymphoma recurrence. After the operation the patient was again able to take food by mouth without problem. Follow-up examination 8 months later showed no recurrence and she was free of gastrointestinal symptoms. CONCLUSION: After chemotherapy for gastrointestinal lymphoma obstruction of the small intestine may occur due to chemotherapy-induced scarring.