A Case of Small Bowel Perforation due to Dialysis-related Amyloidosis

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  • 透析アミロイドーシスによる小腸穿孔の1例
  • 症例 透析アミロイドーシスによる小腸穿孔の1例
  • ショウレイ トウセキ アミロイドーシス ニ ヨル ショウチョウ センコウ ノ 1レイ

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Abstract

We present a case of small bowel perforation due to dialysis-related amyloidosis in a patient who had been on hemodialysis for a long time. The patient was a 62-year-old man who was introduced hemodialysis at the age of 30 and underwent left carpal tunnel release surgery for left carpal tunnel syndrome at the age of 47. Thereafter he had undergone surgeries for osteoarthropathy. The patient presented to our hospital because of high fever and abdominal pain. An abdominal CT scan showed a localized wall thickening at the ileum and an increase in the density of mesenteric fatty tissue. A defect was present at a part of the thickening bowel wall, to which gas image continued extramurally. From these findings, small bowel perforation was diagnosed and an emergency laparotomy was performed. Upon laparotomy, we saw a perforated portion in the ileum and performed partial resection of the small intestine including the perforation and functional end-to-end anastomosis immediately. The histopathology revealed deposits of amyloid in the submucosal layer and vessels around the perforated portion. After the operation he developed vomiting and intractable diarrhea, but he was transferred to other hospital on the 52nd postoperative day. No clinical findings suggestive of suture failure were observed in his postoperative clinical course.

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