AL-amyloidosis of the small intestine complicated by massive bleeding
Abstract
Background. As known gastrointestinal amyloidosis is an uncommon disorder. Bleeding
caused by amyloid deposition in the wall of small intestine vessels is one of
the severe and serious complications of gastrointestinal amyloidosis associated
with multiple non-specific clinical manifestations. Misdiagnosis and inadequate
treatment of acute bleeding could lead to a lethal outcome.
To present a case
report of the patient with amyloidosis of the small bowel that manifested as
massive intestinal bleeding and was initially misdiagnosed as multiple vascular
malformations of the small intestine.
Methods and
results. A 60-year-old patient was admitted to the
gastroenterology department complaining of epigastric pain and black stool.
Esophagogastroduodenoscopy and enteroscopy revealed an area of dense off-white
infiltrated mucosa with accentuated vascular pattern and damage problems of the
mucosal surface caused by scope passage. Biopsy specimen was taken for
pathological verification of diagnosis and tattoo of the defect was performed.
Pathomorphological assessment included Congo red staining that highlighted the
eosinophilic material in the proper mucous plate, adjacent submucous layer and
in the vascular walls which showed apple-green birefringence under polarized
light typical for amyloid. Immunohistochemical typing of amyloid revealed a
positive reaction with the antibody against amyloid P-component and AL-lambda
amyloid.
Conclusion. The presented clinical case has demonstrated the complexity and
versatility of diagnosing amyloidosis of the small intestine.
Keywords:amyloidosis; small intestine; intestinal bleeding; AL-lambda amyloidosis; malformation
Funding. This research was funded by the Russian Science Foundation, grant No.
23-15-00138.
Conflict of
interest. The authors declare no conflict of interest.
For citation: Gioeva Z.V., Vandysheva R.A., Biryukov A.E., Seleznev D.E., Gutyrchik
N.A., Mkhitarov V.А., Pechnikova V.А., Midiber K.Yu., Mikhaleva L.M.
AL-amyloidosis of the small intestine complicated by massive bleeding. Clinical
and Experimental Surgery. Petrovsky Journal. 2023; 11 (3): 137–43. DOI: https://doi.org/10.33029/2308-1198-2023-11-3-137-143 (in Russian)
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