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Gastric lymphoma at high risk of perforation successfully managed with chemotherapy alone
  1. Mohammed Umar Pervez1,
  2. Bhaskar Kumar2,
  3. Pedro Martin-Cabrera3 and
  4. Angela Collins4
  1. 1Norwich Medical School, University of East Anglia, Norwich, UK
  2. 2Upper Gastrointestinal Surgery, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
  3. 3Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  4. 4Haematology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
  1. Correspondence to Mohammed Umar Pervez; umarpervez97{at}


We report the case of a previously healthy 49-year-old woman who presented with upper gastrointestinal bleeding, which was found at laparotomy to be due to high-grade B cell gastric lymphoma. CT scans showed that this was partially adherent to the spleen, with erosion of the gastric wall and suggested impending perforation. Given the risk of perforation, further surgical intervention (gastrectomy and splenectomy) was considered; however, after multidisciplinary team discussion, we chose to offer chemotherapy and careful inpatient observation instead.

Our patient made a full recovery with no perforation.

The message from our experience and literature review is that medical management may lead to a more favourable outcome in gastric lymphoma than surgery, despite radiological appearances suggesting impending perforation. This approach avoids the risk of the lymphoma progressing at other anatomical sites secondary to delays in giving chemotherapy. If this approach is followed, the patient must be carefully monitored.

  • GI bleeding
  • ulcer
  • haematology (incl blood transfusion)
  • gastric cancer
  • general surgery

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  • Contributors MUP interrogated the patient, performed a literature search and wrote the first draft of the manuscript. AC provided haematology expertise and was a major contributor in writing the manuscript. BK provided valuable surgical insight. PM-C provided images of the histopathology slides. All authors read and approved the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.