Abstract
Two cases of perforation of the colon caused by gastrointestinal amyloidosis are reported.
Patient 1 was a 49-year-old man who had a 21-year history of hemodialysis. He underwent an emergency operation with a diagnosis of perforating peritonitis while he was hospitalized for abdominal pain. At laparotomy, perforation about 10mm in diameter was present at the splenic flexure of the colon. A colectomy and a colostomy were performed. Patient 2 was a 55-year-old woman who had been treated for rheumatoid arthritis since the age of 38. She underwent an emergency operation with a diagnosis of perforating peritonitis while she was hospitalized in the depaprtment of internal medicine in our hospital because of intestinal obstruction. At operation, a pinhole like perforation was found in the midst of the transverse colon. The perforated portion with a margin was resected and sutured.
Histopathological studies of the resected materials from both cases revealed deposits of eosinophilic anhistic component to vascular walls and muscular layers in the vicinity of the perforation, which were Congo red-positive, indicating deposits of amyloid. Perforation of the colon caused by dialysis amyloidosis was diagnosed in the patient 1 and he is still alive at present. The patient 2 who was diagnosed as having colonic perforation due to amyloidosis secondary to rheumatoid arthritis died on the 7th postoperative day.
