Secondary high-malignant MALT-lymphoma of the the stomach in a 69-year-oldpatient with a gastrocolic fistula

A 69-year-old man was referred to our department with an exorbitant foetor ex ore, dysphagia and dyspepsia. Upper endoscopy had been performed prior b y an outpatient gastroenterologist and the patient had received an eradicat ion therapy for a Helicobacter pylori-induced gastritis. At admission upper endoscopy showed a gastric ulcer which drained a stinkin g fluid. Endosonography, computed tomography and an upper gastrointestinal series with water soluble media revealed a gastrocolic fistula. Multiple bi opsies showed a low-grade gastric MALT lymphoma. Therefore, a surgical reco nstruction with Roux-en-Y esophagojejunostomy and transverso-descendostomy was performed. The histology of the completely removed stomach revealed a h igh-grade Non Hodgkin Lymphoma (NHL) with parts of a low-grade NHL. 3 weeks after surgery chemotherapy was started with the CHOP-regime which was well -tolerated by the patient.