Die Amyloidose des Dünndarms als seltene Differenzialdiagnose eines chronischen Ileus nach Whipple-Operation

Abstract

When patients who underwent a Whipple operation because of a tumour of the pancreas develop symptoms of chronic ileus several months after surgery, the most common cause is a relapse of tumour growth or a peritoneal carcinomatosis. In this paper we report that secondary amyloidosis of the small intestine can produce similar symptoms and has to be evaluated as a rare differential diagnosis in chronic ileus. Three patients (2 men: 82, 70 years old and 1 woman 70 years old) were admitted to our hospital with symptoms of chronic ileus. All of them had undergone a Whipple operation several months (4, 5, 13 months) before. In two patients surgery was performed due to carcinoma in situ and in one patient due to benign cystadenoma of the pancreas. Chronic ileus resulted in relaparotomy in all patients. Surprisingly, the intraoperative situs did not show any tumour growth. Instead severe adhesions of the small intestine were detected. The entire small intestine was covered with a substance that had a similar aspect to sugar icing. Thereby the motility of the small intestine was constricted. An extensive adhaesiolysis and a decompression of the bowel was carried out. By histopathology, amyloidosis was diagnosed using congo red staining. Diffuse amyloid deposits were found on the small intestine. In the postoperative course two patients could be discharged free of complaints after 7 to 9 days in the hospital. One man died four months later, after transfer to a geriatric hospital, because of intestinal atony and a serious senile depression. Secondary amyloidosis following the Whipple operation is a rare reason for the symptoms of chronic ileus. Surgeons have to keep in mind that amyloidosis is a possible differential diagnosis in addition to relapse of tumour growth and peritoneal carcinomatosis in these patients. Thus, in our opinion, relaparotomy should be undertaken as early as possible because this is the only chance to detect the cause of chronic ileus.