A Case of Primary Amyloidosis Found Out with Megacolon and Perforation of the Right-side Colon

Takehiro Sakai, Koichi Sato, Toru Tamura, Masanori Tanaka* and Yasuhiro Sudo

Department of Surgery and Department of Pathology and Laboratory Medicine*, Hirosaki City Hospital

A 60-year-old man admitted for abdominal pain was found in chest and abdominal imaging to have free air under the diaphragm and marked dilation of the transverse colon. Based on a diagnosis of perforation peritonitis, we undertook emergency laparotomy. The colon was markedly dilated and the intestinal wall was thin and dark red. We found a colonic perforation at the hepetic flexure, and conducted right hemicolectomy with primary end-to-end anastomosis. Histologically, amyloid was seen throughout the entire colon layer. Congo red staining was positive both before and after treatment with potassium permanganate, and the protein component of the amyloid fibers corresponded to type AL fibers. Although the patients suffered postoperatively respiratory failure, retoperitoneal abscess formation, and wound infection, he recovered and was discharged ambulatory on postoperative day 55. Colonic perforation is one of the severest complications of gastrointestinal amyloidosis, which must be considered in patients with idiopathic digestive tract perforation. Although our patient was successfully treated without anastomotic failure, evaluation and appropriate digestive tract and organ follow-up is essential.

Key words
amyloidosis, perforation, colon

Reprint requests
Takehiro Sakai Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine
5 Zaifu-cho, Hirosaki, 036-8562 JAPAN

Accepted
November 28, 2007

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