Sigmoid Colon Perforation in a Case with Dialysis-Related Amyloidosis

A 56-year-old male had a 20-year-history of hemodialysis HD for chronic renal failure of an unidentified cause. He had a surgical history for destructive spondyloarthropathy DSA 53 years old and bilateral carpal tunnel syndrome CTS 55 years old . With chief complaints of abdominal pain and fever at 38 39 C, he was admitted to the hospital in May 2004. On admission, body temperature was 36.1 C and blood pressure was 101 61 mmHg. Physical examination revealed tenderness at the left lower abdomen. WBC was elevated to 14,000 ml and CRP was 15.6 mg dl. Abdominal CT demonstrated free air, and perforative peritonitis was diagnosed. On the same day, emergency partial sigmoidectomy with colostomy was performed. Macroscopically, there was a perforation in the resected sigmoid colon. Pathologically, amyloid deposits were observed in the vascular walls of the submucosal layer. On admission, b2microglobulin was as high as 36.3 mg l, and dialysis-related amyloidosis seemed to be involved in the ischemia-associated intestinal perforation. Taken together, in patients undergoing long-term HD, dialysisrelated amyloidosis should be considered as a risk factor for intestinal perforation.