Perforation of the sigmoid colon and massive ischemia of the small intestine caused by amyloidosis associated with multiple myeloma: a case report.

Abstract

Amyloidosis is a metabolic disease that results in organ dysfunction because of the deposition of amyloid proteins in body tissues and organs. Amyloid accumulation in the gastrointestinal tract can lead to severe complications with poor outcomes. We report a case showing simultaneous perforation of the sigmoid colon and massive segmental intestinal ischemia caused by amyloidosis associated with multiple myeloma. A 75-year-old woman presented to the emergency department in our hospital with a chief complaint of abdominal pain. Results of several examinations indicated sigmoid colon perforation and acute generalized peritonitis. She underwent an emergency exploratory laparotomy. Operative finding was a perforation of the sigmoid colon and many segmental discoloration sites appeared intraoperatively in the small intestine. A loop colostomy was performed by employing a double-barrel ileostomy with a massive resection of the segmentally discolored small bowel. Pathological findings suggested that the causative factor was amyloidosis with multiple myeloma. The patient was successfully treated with adequate surgery and with melphalan and prednisone after the operation. Meticulous and appropriate treatment for severe complications involving amyloidosis associated with multiple myeloma can prevent a fatal outcome.