Management of an uncommon T-Cell lymphoma revealed by an anastomotic dehiscence in Crohn's disease: A case report. (February 2021)

• Record Type: Journal Article
• Authors: Haddad, Anis; Ben Mahmoud, Ahmed; Maghrebi, Houcine; Chelly, Baya; Jouini, Mohamed; Kacem, Montasser Jameleddine
• Is Part Of: International journal of surgery case reports. Volume 79(2021)
• Page Start: 53
• Page End: 57
• Publication Date: 2021-02
• Subjects: Crohn's disease -- Immunosuppressants -- T-cell lymphoma; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2021.01.011
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: The association of cancer and crohn's disease is well known. Immunosuppressants are associated with a carcinological risk. The onset of T-cell Lymphoma in the course of crohn's disease is a very rare finding. The revelation of non-hodgkin lymphoma by anastomotic dehiscence in crohn's disease is not well documented in literature. Abstract: Introduction and importance: T-cell lymphoma degeneration in pancolic crohn's disease is scarce. It is mostly related to long-standing inflammatory bowel disease in patients under immunosuppressants. We reviewed the clinical, endoscopic, radiological and histologic data of the patient as well as the literature dealing with T-cell lymphoma arising from pancolic crohn's disease. Case presentation: We describe in this paper an unusual case of a female young patient who underwent emergency surgery for per endoscopic perforation of the right colon while being under azathioprine. She had a subtotal colectomy with ileostomy and sigmoidostomy. After six months, we restored the digestive continuity through an ileorectal anastomosis. She was kept in remission on azathioprine. After one year, she presented with a pelvic abscess revealing a dehiscence of the ileorectal anastomosis leading to a surgical drainage and resection of the anastomosis associated with terminal ileostomy and closure of the rectal stump. Pathology examination revealed T cell lymphoma arising from the ileorectal anastomosis. Discussion: Patients with long-standing IBD have an increased risk of developing colorectal cancer. The onset of a malignant lymphoma during the course of the CD is scarce. Some studies haves failed to identify crohn's disease as a risk factor of lymphoma whereas other ones have succeeded to. Immunosuppressants are reported to have carcinogenic effect. Rarely, lymphoma degeneration can be revealed by intestinal complications such as perforation like in our case. Conclusion: Many studies reported lymphoma degeneration of crohn's disease after long-term immunosuppressant therapy. However, rapid T-cell lymphoma degeneration revealed by anastomotic dehiscence in crohn's disease made our case unique and interesting.