2020 Volume 53 Issue 7 Pages 419-425
This case involved a 57-year-old male with a history of chronic hepatitis C and chronic glomerulonephritis. He had undergone hemodialysis for 42 years and peritoneal dialysis for 5 months for end-stage renal failure caused by chronic glomerulonephritis. During maintenance hemodialysis at a nearby clinic, he developed intestinal obstruction. Computed tomography (CT) revealed gallstones, pancreatic duct dilation, and ascites, and blood tests showed high levels of trypsin and pancreatic phospholipase A2. However, a close examination performed at the Department of Gastroenterology of another hospital excluded pancreatitis, and he was referred to our hospital for further scrutiny and treatment. An emergency laparotomy was performed because an abdominal abscess and free air were found on CT. However, as septic shock occurred during the operation, the cause of the abdominal abscess was not investigated. Instead, intraperitoneal irrigation was performed, and the operation was completed. Despite intensive care, involving mechanical ventilation and continuous hemodiafiltration, metabolic acidosis and disseminated intravascular coagulation progressed, and the patient died on the 13th postoperative day. A histopathological examination led to a diagnosis of dialysis-related amyloidosis of the gastrointestinal tract, liver, pancreas, and heart; encapsulating peritoneal sclerosis; and a peritoneal abscess.
