A Case of Gastrointestinal Amyloidosis which Began with Ileus and was Revealed by Biopsy of Intraabdominal Lymph Node

Chikao Yasunaga, Fumio Inoue, Yasuaki Mori, Toshiro Koga

Department of Surgery, Nishiarita Kyoritsu Hospital

We reported a case of primary AA type amyloidosis, which involved the gastrointestinal tract. A 66-year-old man was admitted with the complaint of epigastric pain and vomiting. An X-ray film of the abdomen showed a large amount of as and fluid retention in the small intestine. A laparatomy was performed under suspicion of adhesion due to a past appendectomy. The operation showed no obstructive lesion in the gastrointestinal tract but there were multiple swollen lymph nodes in the mesenterium. Pathological examination revealed amyloid deposition in the lymph node. The amyloid was immuno-histochemically type AA. Postoperative endoscopic examination revealed amyloid deposition in the stomach and colon: it was especially severe and extensive in the stomach. No preceding disease was revealed by postoperative examination. That suggested that this was a case of primary amyloidosis of the AA-type. The patient was put on intravenous hyper-alimentation and treated with dimethyl sulfoxide but he died of a gastrointestinal hemorrhage and electrolyte imbalance. We believe that an intraoperative biopsy of lymph node is diagnostically valuable when the origin of ileus is unknown.

Key words
amyloidosis, gastrointestnal tract, ileus

Reprint requests
Fumio Inoue Department of Surgery, Nishiarita Kyoritsu Hospital
2485-3 Ooki-otsu, Nishiarita-machi, Nishimatsuura-gun, Saga, 849-41 JAPAN

Accepted
April 17, 1991

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