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Spontaneous intestinal lesions in lymphomas and neoplastic diseases

Author: 
Graziano Giorgio Maria, Paolo Antonino Buffone and Antonino Graziano
Subject Area: 
Health Sciences
Abstract: 

Introduction: The incidence of lymphomas is around 20 cases per 100,000 inhabitants. is largely influenced by geographic, racial and age factors, resulting higher in industrialized countries A complication that frequently arises in these patients is the acute abdomen of unclear etiology The purpose of this study is to evaluate the causes that determined the increase in spontaneous ileocolic perforation events after chemotherapy treatment Materials and methods: From January 2015 to December 2018 consulted the database of the specialist department II AOU Policlinico University of Catania 52 cases of neoplastic pathology associated with perforation events after chemotherapy of which: n 20 (38.5%) patients diagnosed with intestinal obstruction, n 25 (48.5%) cases with acute colon diverticulitis (sigmoid colon), and 7 cases (13%) of intestinal ischemia. 61% of the cases were female and 49% of the male cases were of average age 75 (range 58-92 y.). The history of symptoms to locate the perforation site. Results: In the first approach to the patient with an acute abdomen as a complication of chemotherapy, it was necessary to evaluate whether the pathology is of surgical relevance, and whether the surgery had to be performed in an emergency or in an emergency or could be delayed. Treatment algorithms have been particularly helpful in this decision. In the unstable patient all the principles of "resuscitation therapy" with fluids were applied, and a slight delay was useful in surgical treatment with a correction of electrolyte imbalances. immediate surgery was required in the following phase in patients suffering from: (peritonitis, pneumoperitoneum, intestinal ischemia and hemodynamic instability). The specific surgical treatment strategies depended largely on a certain diagnosis. Discussion: The severity of the toxic side effect to chemo depends on the extent of the clinical manifestation and its duration which can increase the risk and complications that have been in the observed cases: a) Immediate: those that appear immediately or within a few hours from the therapy, b) sub Acute: those that appear within a few weeks c) Late: those that appear months or years after the therapies. The most fearsome complication was organ toxicity leading to a paralytic ileus [vinca alkaloids] (abdominal distension, marked constipation, abdominal pain) up to ischemia or perforation. Conclusions: Post chemotherapy intestinal perforation is not a well-defined pathology but a set of morbid conditions that require a "tailor-made" approach.

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