A Case with Successful Surgery for Small Bowel Perforation due to Secondary Amyloidosis accompanied by Chronic Rheumatoid Arthritis

Toshiharu Ida, Masahumi Yoshida, Kou Iizuka, Takahiro Serizawa and Yasunori Murakami

Department of Surgery, Kofu Kyouritsu Hospital

Intestinal perforation due to amyloidosis is rare and its prognosis is very poor. We report survival through emergently surgery for a small bowel perforation due to secondary amyloidosis. A 79-year-old woman with a history of chronic rheumatoid arthritis (RA) since age 40, underwent emergency surgery for panperitonitis due to intestinal preforation. Laparotomy showed a perforation 3 mm in diameter at the ileum 1 m from the ileocecal region. We resected about 80 cm segment of the ileum including the perforation, which was abnormally colored and thewall thickened. Mucosa of the resected ileum had multiple ulcers of different sizes. Histopathologicial examination showed amyloid deposits in the submucosal vascular wall. Immunohistochemical staining of amyloid showed amyloid A protein. Amyloidosis in this patient may have been secondary to RA. She left parenteral nutrition after 3 months and her recovery in the last year has been uneventful.

Key words
small intestinal perforation, secondary amyloidosis, rheumatoid arthritis

Reprint requests
Toshiharu Ida Department of Surgery, Kofu Kyouritsu Hospital 1-9-1 Takara, Kofu, 400-0031 JAPAN

Accepted
July 24, 2002

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