Abstract
Aim and Background
We present the first case of laparoscopy-assisted resection of a mid-ileal stricture that developed four months after completion of chemotherapy in a four-year-old boy with B-cell Non-Hodgkin lymphoma (BNHL). There are very few reports in the literature of intestinal strictures developing after chemotherapy in paediatric patients with lymphoma. The underlying pathophysiology is yet to be elucidated. To date, the mainstay treatment modality has been surgical resection through a laparotomy. There are unique considerations when planning surgery in the oncology patient, especially in those that need a prompt recovery to resume ongoing chemotherapy that may be delayed whilst recovering from the stresses of a laparotomy. Novel techniques such as endoscopic dilatation have been considered in such patients to avoid a laparotomy, but long-term benefits have yet to be demonstrated. This is the first reported case to have been managed through the laparoscopic approach.
Case Report
Our four-year-old patient presented with a two-month history of intermittent abdominal pain and distension, having completed chemotherapy for B-NHL four months previously. Imaging confirmed partial intestinal obstruction. We perform a diagnostic laparoscopy that revealed a mid-ileal stricture. We were able to proceed to a laparoscopic-assisted resection of the ileal stricture, thereby avoiding the need for a laparotomy incision.
Results
Our patient made a good post-operative recovery with no complications. There was no evidence of recurrent symptoms at one-year follow-up. Histopathology confirmed a localised stricture with features attributed to the effects of chemotherapy.
Conclusion
The particular benefits of laparoscopy in the oncology patient have become well-recognised in adult surgical oncology. Its role in paediatrics is still evolving, though it is currently predominantly accepted for its diagnostic role. There are very few documented cases of intestinal strictures developing after chemotherapy in paediatric patients with lymphoma. None of the published cases have been managed through the laparoscopic approach. We found laparoscopy to be a very useful alternative approach both as a diagnostic and therapeutic tool in the management of this uncommon case, enabling an excellent outcome in our patient.
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Malakounides, G., John, M., Sultan, S. et al. Laparoscopic surgery for an ileal stricture secondary to chemotherapy in paediatric B-cell non-Hodgkin lymphoma. Hellenic J Surg 85, 408–413 (2013). https://doi.org/10.1007/s13126-013-0076-7
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DOI: https://doi.org/10.1007/s13126-013-0076-7