EXTENSIVE PNEUMOPERITONEUM DURING TREATME NT OF A LYMPHOMA WITH METHOTREXATE AND CYTOSINE-ARABINOSIDE

History and clinical findings: A 58-year-old man was treated for abdom inal and inguinal recurrence of a centroblastic non-Hodgkin lymphoma w ith high doses of methotrexate and cytosine arabinoside. A chest radio gram, taken on the 18th day of chemotherapy to exclude pulmonary infil tration, revealed pneumoperitoneum, The patients's complaints were mer ely of abdominal fullness and persisting diarrhoea, His general state was hardly impaired, the abdomen soft on palpation with active perista lsis. Investigations: There was aplastic anaemia (haemoglobin 9.9 g/dl , erythrocytes 3.4 x 10(6)/mu l, white cells 1000/mu l, platelets 2000 0/mu l, Plain film of the abdomen and abdominal computed tomography co nfirmed pneumoperitoneum. Intraluminal air had caused wall dissection in the ascending and transverse colon (pneumatosis coli as cause of th e pneumoperitoneum). Treatment and course: There was complete absorpti on of the free abdominal air by the 29th day of chemotherapy under par enteral nutrition and metronidazole (3 x 500 mg daily).