Misdiagnosis of subacute perforated peritonitis in gastric malignant lymphoma

Surgical paper XI

Misdiagnosis of subacute perforated peritonitis in gastric malignant lymphoma 

A Case Report

Case Presentation

A 71-year-old female patient, with the medical record number 13520, experienced intermittent periumbilical abdominal pain for 10 days, without accompanying diarrhea, hematochezia, or fever. She was admitted to the Affiliated Hospital of Anhui Medical University on March 22, 1987, with severe colic in the right lower abdomen and vomiting lasting for two days. She was initially suspected to have appendiceal perforation.

Clinical Examination

Upon admission, the patient had a temperature of 35.5°C, a pulse rate of 84 beats/min, and a blood pressure of 120/80 mmHg. She appeared acutely dehydrated with general nutrition. No lymphadenopathy or jaundice was observed. Physical examination revealed tenderness and rebound tenderness throughout the abdomen, especially in the right lower quadrant. Laboratory tests showed decreased hemoglobin levels (9 g/mm3), RBC count of 3.8 million/mm3, and a WBC count of 19,700/mm3 with 91% neutrophils and 9% lymphocytes. Urine amylase was 16 units/Winsler.

Surgical Findings

The patient underwent emergency surgery on the day of admission for suspected acute appendicitis with peritonitis. During the procedure, a small amount of intra-abdominal exudate was found, but no obvious purulent fluid was observed. The appendix, gallbladder, liver, spleen, and pancreas appeared normal. However, a 5x6 cm mass was discovered on the anterior wall of the gastric antrum, with a soft texture and focal necrosis at its center.

Histopathology and Postoperative Care

Histopathological examination confirmed the diagnosis of malignant lymphoma of the gastric antrum. The patient was discharged after 12 days of hospitalization and showed no signs of recurrence during the one-year follow-up.


Gastric malignant lymphoma accounts for 80% of gastric sarcomas and often presents with insidious and non-specific symptoms, making preoperative diagnosis challenging—only 10% are accurately diagnosed before surgery. These tumors may result in peritonitis due to necrosis and exudation, often misleadingly presenting as appendicitis.

For patients with a prolonged history of symptoms but no localized inflammatory mass, the possibility of this rare condition should be considered. Excision of sufficient gastric tissue and omentum generally leads to a more favorable prognosis than gastric cancer, with a 5-year survival rate up to 50%. In this case, the patient remained symptom-free at the one-year follow-up.



Waltar LJ, et al. Cancer Management. New York, 1977; p.269.


This article was originally published in Proceedings of First Health Conference of the Yangtze River Shipping Company,1988;4:1
Changhang Hospital, Li Mingjie





立委博士,问问副总裁,聚焦大模型及其应用。Netbase前首席科学家10年,期间指挥研发了18种语言的理解和应用系统,鲁棒、线速,scale up to 社会媒体大数据,语义落地到舆情挖掘产品,成为美国NLP工业落地的领跑者。Cymfony前研发副总八年,曾荣获第一届问答系统第一名(TREC-8 QA Track),并赢得17个小企业创新研究的信息抽取项目(PI for 17 SBIRs)。


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