SP1.9 Emergency laparotomy for abdominal catastrophes secondary to lymphoma: a systematic review

Abstract

Abstract Aim Intestinal lymphomas can rarely present as abdominal catastrophes with perforation or small bowel obstruction. There is little data regarding their optimal surgical management and associated outcomes. We aimed to systematically review relevant published literature to assess optimal surgical approach and post-operative outcomes. Methods A systematic on-line literature search of Embase and Medline identified 1485 articles of which 34 relevant studies were selected, including 7 retrospective studies, 1 case series and 26 case reports. Selected articles were assessed by two reviewers to extract relevant data. Results 95 patients with abdominal catastrophes secondary to lymphoma (predominately Burkitt (28%) and Diffuse Large B-cell lymphoma (29%)) were identified with a median age of 52 years, 40% female. The most common presentation was perforation in 69% of patients compared to obstruction (28%) and ischaemia (2%). The most common site of perforation was the ileum (32%), followed by the jejunum (27%). Small bowel resection and primary anastomosis (76%) was the most common procedure performed followed by ileocolic resection (11%), primary repair (4%) and defunctioning stoma (3%). Of those receiving small bowel resection 25% (n=18) suffered post-operative complications with a 30-day mortality of 13.8% (n=10). This compared favourably to those receiving ileocolonic resections (27% complications 18% mortality) or primary repair (25% complications and 25% mortality). Median follow-up was 8 days (range 1-96). Conclusion Abdominal catastrophes secondary to intestinal lymphomas are most commonly present with perforation. If suitable intra-operatively, small bowel resection offers the most favourable short-term outcomes with the lowest levels of morbidity and 30-day mortality.