Abstract
A 77-year-old man with no significant past medical history visited our hospital with a history of abdominal distention, anorexia and vomiting. An abdominal X-ray revealed small-bowel distention, and the patient was able to consume only liquid, but not solid food. Initially, we attempted conservative therapy by intravenous hyperalimentation and enteral feeding, but no improvement was noted. Eventually, we diagnosed the patient as having a small-intestinal tumor and scheduled treatment by operation. The intraoperative findings included a thin-walled, distended small-intestinal segment measuring 150 cm from Treitz's ligament, which was resected. Histopathology revealed AL amyloid deposits in the wall of the resected intestinal segment. Bone marrow examination revealed monoclonal gammopathy of undetermined significance (MGUS). Japanese guidelines on amyloidosis recommend chemotherapy for AL amyloidosis. However, we decided against chemotherapy for our patient, as he had been able to resume normal oral intake following the surgery alone. Moreover, he had no other severe organ disorder and expressed the fear of side effects of chemotherapy on his quality of life. At present, 3 years since the surgery, the patient remains free of symptoms. Thus, for cases of small intestinal amyloidosis, surgery can represent a useful treatment option, and chemotherapy may not be needed.
