Abstract
We report a case of amyloidosis which presented with intractable intestinal obstruction due to severe narrowing of the small intestine and was definitely diagnosed as amyloidosis by pathological exploration of the excised material.
The patient was a 74-year-old woman who had recurrent bouts of symptoms of intestinal obstruction including abdominal pain, abdominal distension, and vomiting as well as diarrhea. She was referred to our department of surgery after unsuccessful conservative therapy at the department of internal medicine in our hospital. Small intestinal fluoroscopy showed severe narrowing of the middle small intestine. Abdominal contrast enhanced CT scan disclosed narrowing of the small intestine and dilatation and wall thickening of the small intestine proximal to the narrowing. The patient was considered probably not to have strangulated ileus, but any cause of the narrowing was still unknown. Thus the patient was operated on with a diagnosis of intractable intestinal obstruction. During surgery the small intestine was shortened to the total length of about 200 cm, when two areas showing severe narrowing were seen. Following small intestinal resection, a side-to-side anastomosis between the jejunum and transverse colon was carried out. Histopathological exploration offered the diagnosis of amyloidosis.
Although intestinal amyloydosis can cause functional intestinal obstruction due to impairment of intestinal movement, it rarely causes mechanical intestinal obstruction due to intestinal narrowing. Accordingly this case is reported here, together with some bibliographical comments.
