Gastroenterostomy in non-Hodgkin B-cell lymphoma complicated by decompensated gastric outlet obstruction

Primary gastric non- Hodgkin lymphomas represent the most common extranodal localization of lymphoproliferative disorders. The current standard of care, first-line immunochemotherapy based on rituximab (R-CHOP and CHOP-like reg imens), demonstrates high efficacy, achieving complete response in the majority of patients. However, 8–25 % of patients develop local life-threatening complications during or after treatment, among which gastric outlet obstruction (pyloric stenosis) is the most common. In routine clinical practice, elective surgical intervention is generally not performed in patients with lymphomas because these tumors are highly sensitive to systemic drug therapy.

This article presents a clinical case of a 49-year-old patient with stage IV extranodal B-cell gastric lymphoma and HIV-positive status, demonstrating the role of palliative surgical intervention. Despite achieving a partial metabolic response to polychemotherapy (EPOCH/R-CHOP regimens), the patient developed decompensated cicatricial- tumorous pyloric stenosis. This complication required active surgical management. Gastrojejunostomy was successfully performed as a palliative procedure, creating a bypass for gastric emptying into the jejunum while circumventing the obstruction site, which significantly improved the patient's quality of life. The postoperative course was uneventful, and no signs of progression of the underlying lymphoproliferative disease were observed during long-term follow-up. An additional advantage of the selected surgical approach was the rapid restoration of the patient's nutritional status while preserving oral feeding.

The presented clinical case confirms the feasibility of an individualized approach to the selection of palliative treatment strategies in patients with complicated gastric lymphoma.

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