Mesorectal Hemorrhage and Rectal Perforation in a Patient with Intestinal Amyloidosis—A Case Report—

Abstract

Intestinal amyloidosis is a rare disease that causes tissue fragility due to amyloid protein deposition in the vascular and intestinal walls. The case of a 66-year-old man who was brought to our hospital by ambulance complaining of sudden lower abdominal pain and melena is presented. Intramesorectal hemorrhage was diagnosed, and emergency surgery was performed. Intraoperatively, a hematoma was observed within the mesorectum, and there was a laceration measuring approximately 3 cm in the posterior wall of the lower rectum (Rb). Hartmann's procedure was performed, including the laceration site and the hematoma. The mucosa of the resected specimen appeared normal on visual examination, but histopathological investigations showed amyloid deposition in the vascular walls of the full thickness of the intestine, and intestinal amyloidosis was diagnosed. It was thought that blood vassels in the mesentery had become fragile and broken down, leading to hematoma formation and rectal perforation. Although intestinal amyloidosis is a known risk factor for mesenteric hemorrhage, only two cases of small bowel mesenteric hemorrhage have previously been reported, including in the foreign literature. Intestinal amyloidosis should be included in the differential diagnosis of cases of intramesenteric hemorrhage or perforation of unknown origin.