A Case Rectal Perforation in Dialysis-related Amyloidosis

Yasuki Unemura, Takuya Nojiri, Masaichi Ogawa, Takeyuki Misawa, Kenji Ikeuchi and Yoji Yamazaki

Department of Surgery, The Jikei University School of Medicine

A 71-year-old woman treated by hemodialysis for 22 years occasionally suffered from abdominal pain, especially in the left lower abdomen. She was examined for diverticula of sigmoid colon and ischemic colitis. In 1997, endoscopic biopsy of the rectal mucosa revealed intestinal amyloidosis. Last January, she was admitted as an emergency case due to lower abdominal pain. The next day, she was diagnosed with bowel perforation and underwent emergency surgery. The posterior wall of the upper rectum had a perforation 1 cm in diameter accompanied by a hard 3 cm stool mass. we conducted partial rectosigmoidectomy including the perforation site and a colostomy. Anti-β₂-microglobulin antibody-positive amyloid deposits were diffusely recognized on the submucosal small vascular walls, among other sites. Ischemia of the rectal wall following amyloidosis appeared to have initiated the perforation, in addition to diverticulitis and mechanical compression by the hard stool. Dialysis-related amyloidosis should thus be recognized as a risk factor in bowel perforation in long-term hemodialysis patients.

Key words
dialysis-related amyloidosis, rectal perforation, generalized peritonitis

Reprint requests
Yasuki Unemura Department of Surgery, The Jikei University School of Medicine 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461 JAPAN

Accepted
October 31, 2000

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