A case of diffuse peritonitis caused by secondary intestinal amyloidosis

Abstract

A 76-year-old man who had been treated for hepatocellular carcinoma and chronic pulmonary emphysema in our clinic was seen at our hospital because of abdominal pain and vomiting. There were abdominal distention and muscular defense in the left upper quadrant of abdomen. Abdominal enhanced CT scan showed thickening and edema of the left colonic wall. Emergency surgery was performed with a diagnosis of diffuse peritonitis. The necrotized left colon was excised followed by colostomy. Although postoperative mechanical ventilation was required, the patient was discharged from the hospital on the postoperative day 39. Histopathological examinations showed Congo-red positive amyloid protein deposits in small vessels of the submucosal layer.
Emergency surgery has occasionally been reported for intestinal amyloidosis associated with chronic rheumatism and long-term hemodialysis. However, few reports have been made of emergency surgery for secondary intestinal amyloidosis in patients without these factors. In this case, AA amyloid protein was determined based on immunostaining, and secondary amyloidosis was diagnosed. However, we could not confirm whether this condition was caused by the malignancy or chronic obstructive pulmonary disease.