A rare case of perforated gastric lymphoma presenting a life-threatening condition: A case report

INTRODUCTION AND IMPORTANCE: Gastric lymphomas are non-Hodgkin's lymphomas originating from mucosa-associated lymphoid tissue (MALT). Surgical intervention is recommended in cases of complications such as obstruction, bleeding, or perforation, although the choice of treatment can be a subject of debate and may entail life-threatening risks. This case report aims to describe a complex case of gastric MALT lymphoma with perforation requiring surgical intervention. CASE PRESENTATION: A 47-year-old patient with a history of extranodal marginal zone B cell lymphoma presented to the Emergency Department with epigastric pain. Physical examination revealed a patient with hemodynamic instability and generalized abdominal tenderness. An abdominal CT scan revealed intraperitoneal air and effusion, along with a gastric wall defect. An emergent laparotomy was performed, revealing widespread purulent peritonitis resulting from a centimetric perforation in the anterior wall of the stomach near the lesser curvature. Following peritoneal lavage, we repaired the perforation and performed external drainage. The postoperative course was complicated by renal failure, and the patient succumbed to the illness two days after surgery. CASE DISCUSSION: Gastric lymphomas, primarily linked to H. pylori infection. Diagnosis relies on endoscopy and histopathology. Endoscopic manifestations vary, making biopsy crucial. H. pylori eradication is the initial treatment, but resistance may require chemotherapy. Gastric lymphoma complications include perforation, with life-threatening consequences. Perforations can occur due to lymphoma or chemotherapy. Timely intervention with suturing is crucial for patient management. The postoperative course is difficult to manage due to the immune system deficiency. CONCLUSION: Bowel perforation in gastric lymphomas significantly contributes to morbidity and mortality. Early diagnosis and emergent surgery are imperative to mitigate complications and reduce septicemia even in young patients.