Massive hemorrhage and pseudo-obstruction of the small intestine caused by primary AL amyloidosis associated with gastric cancer: report of a case

We report a case of AL amyloidosis in a patient diagnosed with early gastric cancer after presenting with massive gastrointestinal hemorrhage and pseudo-obstruction of the small intestine. Primary systemic amyloidosis accounts for 7% of nonhematological malignancies, but very few cases of gastric carcinoma in patients with primary amyloidosis have been described. We performed distal gastrectomy with biopsy of the small intestine in the absence of a diagnosis of systemic amyloidosis associated with early gastric cancer; however, the patient suffered severe postoperative complications secondary to the amyloidosis. Although acute pseudo-obstruction is an uncommon clinical manifestation of AL amyloidosis, the coexistence of both gastrointestinal hemorrhage and pseudo-obstruction of the small intestine should alert the clinician to a diagnosis of gastrointestinal amyloidosis. We discuss the clinical manifestations of primary amyloidosis occurring in association with gastric cancer.