A case of non-occlusive mesenteric ischemia complicated by gastrointestinal amyloidosis

A 71-year-old man was admitted to our hospital complaining of appetite loss. An esophagogastroduodenoscopy (EGDS) revealed poor distensibility of the antrum wall, and an abdominal CT showed a markedly thickened stomach wall. A biopsy of the gastric wall was performed to test for scirrhous gastric cancer but no malignancy was found. One month later, the patient’s appetite loss worsened, and a second EGDS was performed, revealing multiple shallow ulcers on the antrum. Eight days later, he passed massive bloody stools and went into shock. CT revealed a remarkably decreased contrast effect on the wall of the small intestine. Because there was no sign of intraperitoneal artery obstruction, non-occlusive mesenteric ischemia (NOMI) was diagnosed. The patient died on the next day. Based on the autopsy findings of amyloid-A protein deposition on the stomach, the diagnosis of AL amyloidosis followed by NOMI was finally made. In retrospect, the direct fast scarlet staining of the biopsy specimen on the first EGDS had demonstrated amyloid-A protein deposition on gastric mucosa. Our findings suggest that amyloidosis should be suspected whenever unidentified digestive symptoms are encountered.