Intestinal pseudo-obstruction as the initial manifestation of intestinal amyloidosis: Report of a case

Intestinal pseudo-obstruction has been described in association with a large number of disease entities. It is rare in intestinal amyloidosis complicating intestinal pseudo-obstruction. We report a case of multiple myeloma associated with intestinal amyloidosis with the initial presentation of intestinal pseudo-obstruction. A 42-year-old woman suffered from intermittent abdominal distention and bloody stool passage for one month. After a series of examinations, terminal ileal lesions associated with partial intestinal obstruction was diagnosed. Exploratory laparotomy was performed under the impression of intestinal lymphoma. Operative findings revealed increased thickness of intestinal wall diffusely from Treitz ligament to terminal ileum and enlarged mesenteric lymph nodes. Histopathologic features revealed massive amyloid deposition in intestinal vascular wall, submucosa and muscular propria. Multiple myeloma was confirmed thereafter by bone marrow biopsy and immunologic study of serum. She received 4 courses of chemotherapy with limited effect. Unfortunately, she died due to massive upper gastrointestinal tract bleeding 3 months after initial diagnosis. In view of intestinal pseudo-obstruction, we suggest that intestinal amyloidosis be kept in mind in the list of differential diagnoses.