回腸穿孔を来した多発性骨髄腫合併全身性アミロイドーシスの1例

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  • A CASE OF ILEAL PERFORATION SECONDARY TO SYSTEMIC AMYLOIDOSIS ASSOCIATED WITH MULTIPLE MYELOMA

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Gastrointestinal perforation accompanied by amyloidosis is very rare. This paper reports a case of ileal perforation secondary to systemicamyloidosis associated with multiple myeloma.<br> The patient was a 70-year-old female. There were previous histories of undergoing chemotherapy for multiple myeloma (IgG-λ type) in 1984, and being diagnosed as amyloidosis by rectal biopsy in March 1987. Seven months later she felt sudden abdominal pain and was admitted to the hospital. Plain abdominal x-ray film revealed free gas. Under a suspected diagnosis of gastrointestinal perforation or panperitonitis, emergency operation was carried out. On laparotomy 1cm size of perforation was found at the ileum about 70cm oral-side from the ileocecal region. The segment of the small intestine including the perforation was resected. She did not recover from postoperative shock and died on the next day. Remarkable deposits of amyloid were pathologically present in the blood vessel walls extend from the submucosa to subserosa. Especially stenosis of the arterial lumen was marked. Only 29 cases of gastrointestinal perforation due to amyloidosis have been reported in the world literature. This patient is the thirtieth case.

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