A Small Intestinal Lesion Causing Intestinal Obstruction—A Case of IgG4-related Disease—

Abstract

A 60-year-old man was admitted to our hospital with abdominal pain. Computed tomography showed localized thickening of the small intestinal wall, resulting in small intestinal obstruction. After decompression with a long international tube, laparoscopic-assisted partial small intestinal resection was performed. The resected specimens showed all-round ulceration and wall thickening in the stenosis, but no obvious neoplastic lesions. Histopathologically, significant lymphocyte and plasma cell infiltration and fibrosis were observed through the entire layer of the wall of the small intestine. The IgG4/IgG-positive cell ratio was >40%, and the number of IgG4-positive plasmacytes was >10 per high power field (HPF). In addition, storiform fibrosis and obliterative phlebitis were observed. Postoperative blood tests showed a high serum IgG4 level of 1007 mg/dl. Based on the above, IgG4-related disease was diagnosed. The patient's postoperative course was good, and as of one year and five months after surgery, no new lesions have been observed.