A CASE OF PERFORATED ULCER OF THE SMALL INTESTINE DUE TO AMYLOIDOSIS CAUSING GENERAL PERITONITIS

We experienced a case of perforated ulcer of the small intestine due to secondary amyloidosis in a 77-year-old woman having an underlying disease of rheumatoid arthritis. The patient was seen at the hospital because of abdominal pain. Based on clinical and imaging findings a diagnosis of general peritonitis due to intestinal perforation was made. Laparotomy was carried out and extended ulcer and perforation of the small intestine were found. Excision of the small intestine and enterostomy were performed. Histopathological examination of the excised specimen revealed deposites of amyloid ranging from the mucosa to submucous vascular wall. This amyloid was determined as AA protein by immunohitological staining. Amyloydosis in this patient might be secondary to RA. It has been reported that RA is the most common underlying disease for secondary amyloidosis. If a patient with RA has gastrointestinal symptoms such as nausea, vomiting, abdominal distension, abdominal pain and diarrhea, possible association of intestinal amyloidosis should be entertained.