VM59 - Robotic Right Colectomy for Ascending Colon Stricture Following Chemotherapy for Diffuse Large B-cell Lymphoma Involving the Colon

Saturday, June 1, 2024

10:00 AM – 1:30 PM ET, USA

Location: Baltimore Convention Center, Hall BCD

Video Presentation(s)

Katherine Rosen, MD, MS (she/her/hers)

Colorectal Surgery Fellow
Northside Hospital
Northside Hospital
Atlanta, GA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

MR

Michelle T. Roper, MD, FACS

Fellow
Georgia Colon and Rectal Surgical Associates
Hampstead, North Carolina, United States

Disclosure information not submitted.
WA

Wayne L. Ambrose, MD

Program Director
Northside Hospital
Sandy Springs, Georgia, United States

Disclosure information not submitted.
MS

Marion Schertzer, MD Facs,Fascrs

Colon and Rectal Surgeon
Northside Hospital
Atlanta, Georgia, United States

Disclosure information not submitted.
TS

Timothy Simon, MD, FASCRS, FACS

colon and rectal surgeon
Northside Hospital
Atlanta, Georgia, United States

Disclosure information not submitted.
Cici Zhang, MD

Colorectal surgeon
Georgia Colon And Rectal Surgical Associates
Atlanta, Georgia, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
PZ

Peige Zhou, MD

Colorectal Surgeon
Georgia Colon and Rectal Surgical Associates, Northside Hospital
Atlanta, Georgia, United States

Disclosure information not submitted.
JL

Jessica Lam, MD

Colorectal Surgeon
Northside Hospital
Atlanta, Georgia, United States

Disclosure information not submitted.

Senior Author(s)

MA

Mohammed Al Fayyadh, MD

Adjunct faculty
Georgia Colon and Rectal Surgical Associates/Northside Hospital Cherokee
Alpharetta, Georgia, United States

Disclosure information not submitted.

Purpose/Background: The purpose of this video was to highlight the rare pathology consisting of sudden transformation of chronic lymphocytic leukemia to a diffuse large B cell lymphoma presenting with symptomatic abdominal distension caused by a hepatic flexure colon mass, omental caking, and peritoneal nodules; as well as the development of a stricture in the affected colon following the patient's treatment with chemotherapy. A secondary purpose was to demonstrate the key steps of a robotic right colectomy with intracorporeal anastomosis in stepwise fashion.

Methods/Interventions: The patient is a 71-year-old man with complex past medical history including coronary artery disease with MI status post CABG, heart failure, hypertension, hyperlipidemia, DVT status post IVC filter (on antiplatelet therapy) and chronic lymphocytic leukemia diagnosed in 2003 and treated with chemotherapy in 2018 (in remission), who presented to the emergency department in 2022 with abdominal distension. CT abdomen/pelvis showed a poorly defined hepatic flexure mass with extensive omental caking with mesenteric and serosal metastatic deposits throughout the abdominal and pelvic cavity. Colonoscopy with biopsy of the hepatic flexure mass revealed diffuse large B cell lymphoma and a tattoo was placed. He was treated with chemotherapy with excellent response on PET/CT. However, he subsequently developed an ascending colon stricture which could not be adequately dilated during endoscopy. Biopsies of the stricture showed colonic mucosa with granulation tissue and reactive changes. The patient underwent an uneventful robotic right colectomy with intracorporeal anastomosis.

Results/Outcomes: The patient tolerated surgery uneventfully and was discharged home on post-operative day 4. Pathology demonstrated a colonic stricture with erosion with granulation tissue and 4 lymph nodes which were negative for malignancy. He was doing well at the time of his post-operative outpatient follow-up visit and is tentatively planned to undergo bone marrow transplant in January 2024.

Conclusion/Discussion: Lymphoma is a relatively rare cause of colonic mass and requires a multidisciplinary approach to both treatment and the management of treatment-related complications. Limitations include those associated with single case reports.