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Hodgkin's disease of intra-abdominal lymph nodes — Clinical Guidelines

Overview

Hodgkin's disease involving intra-abdominal lymph nodes is a rare manifestation of Hodgkin lymphoma, often presenting with nonspecific abdominal symptoms that can complicate early diagnosis, particularly in elderly patients where clinical presentation may be atypical 2 5.

Diagnosis

Clinical Presentation: Nonspecific abdominal pain, mass effect, and systemic symptoms like fever 2.

Imaging: Abdominal CT is superior for lesion detection, especially in larger patients, though abdominal ultrasound can be useful as a first-line screening tool 3 4.

Intraoperative Diagnosis: Often confirmed during exploratory surgery due to challenging preoperative diagnosis 1.

Management

Surgical Intervention: Exploratory laparotomy may be necessary for definitive diagnosis and staging 1.

Chemotherapy: Standard treatment involves anthracycline-based regimens (e.g., ABVD: doxorubicin, bleomycin, vinblastine, dacarbazine) 5.

Radiation Therapy: Often used in conjunction with chemotherapy, particularly for advanced stages or bulky disease 5.

Special Populations

Elderly Patients: Higher morbidity and mortality associated with emergency abdominal surgery; elective procedures are preferred to reduce complications 5 6.

Diagnostic Challenges: Geriatric patients may present with atypical symptoms, necessitating heightened clinical suspicion 2.

Key Recommendations

Utilize Advanced Imaging: Employ abdominal CT for definitive diagnosis, especially in larger patients, to detect lesions more accurately (Evidence: Moderate 3 4).

Avoid Emergency Surgery When Possible: Opt for planned elective surgical interventions in elderly patients to minimize mortality and morbidity (Evidence: Moderate 5 6).

Standard Chemotherapy Regimens: Implement anthracycline-based chemotherapy regimens such as ABVD for treatment, supplemented by radiation therapy as needed (Evidence: Moderate 5).

References

1 Gumerov AA, Neudachin AE, Mingulov FF, Bayazitov RR, Gumerov RA, Vagapova VS et al.. [Rare abdominal diseases in emergency surgery]. Khirurgiia 2018. link 2 Magidson PD, Martinez JP. Abdominal Pain in the Geriatric Patient. Emergency medicine clinics of North America 2016. link 3 Fields EL, Robertson ID, Osborne JA, Brown JC. Comparison of abdominal computed tomography and abdominal ultrasound in sedated dogs. Veterinary radiology & ultrasound : the official journal of the American College of Veterinary Radiology and the International Veterinary Radiology Association 2012. link 4 Fields EL, Robertson ID, Brown JC. Optimization of contrast-enhanced multidetector abdominal computed tomography in sedated canine patients. Veterinary radiology & ultrasound : the official journal of the American College of Veterinary Radiology and the International Veterinary Radiology Association 2012. link 5 Arenal JJ, Bengoechea-Beeby M. Mortality associated with emergency abdominal surgery in the elderly. Canadian journal of surgery. Journal canadien de chirurgie 2003. link 6 Burns GP, Parikh SR. Abdominal surgery in the elderly patient. Clinics in geriatric medicine 1990. link

Hodgkin's disease of intra-abdominal lymph nodes