Skip to main content

Advertisement

SpringerLink
Log in

A case of intestinal intussusception with unique hemorrhagic polyps due to AL amyloidosis and excessive anticoagulation

  • Case Report
  • Published:
Clinical Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Most adult intussusceptions are secondary to various pathological conditions that serve as a lead point. Because of their serious nature, intussusceptions often require emergency surgery. We report a surgical case of amyloidosis associated with intussusception, probably due to polypoid protrusions and bleeding tendencies. An 80-year-old man with abdominal pain was suspected of having jejunal intussusception on computed tomography. He had been prescribed warfarin for atrial fibrillation, and excessive anticoagulation was observed with a prolonged prothrombin time/international normalized ratio of 5.44 at presentation. After the excessive anticoagulation was resolved, emergency surgery was performed. The intussuscepted jejunum was resected, and a 7 cm long dark-red pedunculated polyp was identified as the lead point, which was accompanied by multiple small pedunculated polyps. Histopathological examination showed that these were all hemorrhagic polyps. Amyloid depositions were observed in the muscularis mucosae, submucosa, and the walls of the blood vessels. Immunohistochemical analysis revealed immunoglobulin light chain amyloidosis. This case is informative to discuss the clinical sequelae of gastrointestinal amyloid deposition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Weilbaecher D, Bolin JA, Hearn D, et al. Intussusception in adults. Review of 160 cases. Am J Surg. 1971;121:531–5.

    Article  CAS  PubMed  Google Scholar 

  2. Stubenbord WT, Thorbjarnarson B. Intussusception in adults. Ann Surg. 1970;172:306–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Akçay MN, Polat M, Cadirci M, et al. Tumor-induced ileo-ileal invagination in adults. Am Surg. 1994;60:980–1.

    PubMed  Google Scholar 

  4. Marinis A, Yiallourou A, Samanides L, et al. Intussusception of the bowel in adults: a review. World J Gastroenterol. 2009;15:407–11.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Felix EL, Cohen MH, Bernstein AD, et al. Adult intussusception; case report of recurrent intussusception and review of the literature. Am J Surg. 1976;131:758–61.

    Article  CAS  PubMed  Google Scholar 

  6. Wechalekar AD, Gillmore JD, Hawkins PN. Systemic amyloidosis. Lancet. 2016;387:2641–54.

    Article  CAS  PubMed  Google Scholar 

  7. Scott PP, Scott WW Jr, Siegelman SS. Amyloidosis: an overview. Semin Roentgenol. 1986;21:103–12.

    Article  CAS  PubMed  Google Scholar 

  8. Gilat T, Revach M, Sohar E. Deposition of amyloid in the gastrointestinal tract. Gut. 1969;10:98–104.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Tada S, Iida M, Yao T, et al. Gastrointestinal amyloidosis: radiologic features by chemical types. Radiology. 1994;190:37–42.

    Article  CAS  PubMed  Google Scholar 

  10. Cui XH, Liu H, Fu L, et al. Henoch-Schonlein purpura with intussusception and hematochezia in an adult: A case report. Medicine. 2019;98:e16981.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Diaz MC, Ramundo ML, Christopher NC. Spontaneous reduction of a small bowel intussusception in a patient with Henoch Schonlein purpura. Am J Emerg Med. 2004;22:323–5.

    Article  PubMed  Google Scholar 

  12. LeBlanc KE. Jejuno-jejunal intussusception in a hemophiliac: a case report. Ann Emerg Med. 1982;11:149–51.

    Article  CAS  PubMed  Google Scholar 

  13. Nakayama Y, Fukushima M, Sakai M, et al. Intramural hematoma of the cecum as the lead point of intussusception in an elderly patient with hemophilia a: report of a case. Surg Today. 2006;36:563–5.

    Article  PubMed  Google Scholar 

  14. Tan HL, Chok AY, Li Y, et al. Systemic Amyloid Light-chain amyloidosis with colonic involvement complicated by colo-colic intussusception. ANZ J Surg. 2020;90:1162–3.

    Article  PubMed  Google Scholar 

  15. Haralabopoulos T, Soo M, Levingston R. An unusual case of gastrointestinal immunoglobulin light chain amyloidosis causing small bowel intussusception. Pathology. 2022;54:S46.

    Article  Google Scholar 

  16. Matsumoto Y, Masuda T, Nishimura A, et al. A case of AL amyloidosis associated with follicular lymphoma with plasmacytic differentiation. Int J Hematol. 2020;111:317–23.

    Article  CAS  PubMed  Google Scholar 

  17. Kitahara T, Washiro M, Yoda A, et al. Gastrointestinal AL amyloidosis associated with intussusception–a case report. J Jpn Surg Assoc. 2022;83:1470–4.

    Article  Google Scholar 

  18. Hokama A, Kishimoto K, Nakamoto M, et al. Endoscopic and histopathological features of gastrointestinal amyloidosis. World J Gastrointest Endosc. 2011;3:157–61.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Koop AH, Mousa OY, Wang MH. Clinical and endoscopic manifestations of gastrointestinal amyloidosis: a case series. Clujul Med. 2018;91:469–73.

    PubMed  PubMed Central  Google Scholar 

  20. Hemmer PR, Topazian MD, Gertz MA, et al. Globular amyloid doposits isolated to the small bowel. Am J Surg Pathol. 2007;31:141–5.

    Article  PubMed  Google Scholar 

  21. Mumford AD, O’Donnell J, Gillmore JD, et al. Bleeding symptoms and coagulation abnormalities in 337 patients with AL-amyloidosis. Br J Haematol. 2000;110:454–60.

    Article  CAS  PubMed  Google Scholar 

  22. James DG, Zuckerman GR, Sayuk GS, et al. Clinical recognition of Al type amyloidosis of the luminal gastrointestinal tract. Clin Gastroenterol Hepatol. 2007;5:582–8.

    Article  PubMed  Google Scholar 

  23. Greipp PR, Kyle RA, Bowie EJ. Factor-X deficiency in amyloidosis: a critical review. Am J Hematol. 1981;11:443–50.

    Article  CAS  PubMed  Google Scholar 

  24. Choufani EB, Sanchorawala V, Ernst T, et al. Acquired factor X deficiency in patients with amyloid light-chain amyloidosis: incidence, bleeding manifestations, and response to high-dose chemotherapy. Blood. 2001;97:1885–7.

    Article  CAS  PubMed  Google Scholar 

  25. Furie B, Voo L, McAdam KP, et al. Mechanism of factor X deficiency in systemic amyloidosis. N Engl J Med. 1981;304:827–30.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the Amyloidosis Research Group of the Ministry of Health, Labour and Welfare (Hironobu Naiki, Team Leader) for classifying the type of amyloidosis.

Author information

Authors and Affiliations

  1. Department of Surgery, Itami City Hospital, 100 Koyaike, Itami, Hyogo, 664-8540, Japan

    Rie Hayashi, Genta Sawada, Yoshitoshi Ichikawa, Akihiro Takata, Masahiro Murakami, Hiroki Fukunaga & Shunji Morita

  2. Department of Diagnostic Pathology, Itami City Hospital, Itami, Hyogo, Japan

    Hayato Kimura

Authors
  1. Rie Hayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Genta Sawada
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshitoshi Ichikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Akihiro Takata
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masahiro Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroki Fukunaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hayato Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shunji Morita
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The first draft of the manuscript was written by RH. SM and HK commented on previous versions of the manuscript and edited. GS, YI, AT, MM, and HF had discussion with the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Rie Hayashi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hayashi, R., Sawada, G., Ichikawa, Y. et al. A case of intestinal intussusception with unique hemorrhagic polyps due to AL amyloidosis and excessive anticoagulation. Clin J Gastroenterol 17, 258–262 (2024). https://doi.org/10.1007/s12328-023-01915-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12328-023-01915-6

Keywords

Search

Navigation