Intestinal pseudo-obstruction due to dialysis amyloidosis

Marked gastric dilatation and the carpal tunnel syndrome developed concurrently in a 58-year-old man treated with hemodialysis for 14 years. Despite extensive examinations, no attributable organic lesion was demonstrated in the gastrointestinal tract. However, amyloid deposition, which was immunohistochemically identified as beta-2 microglobulin, was demonstrated in the stomach and the synovia excised from the right carpal tunnel. Intestinal pseudo-obstruction due to dialysis amyloidosis was considered to be the cause of the gastric dilatation. There have been a few recently reported cases with dialysis amyloidosis in which extra-articular amyloid deposition resulted in overt clinical problems. The present case provides additional evidence that dialysis amyloidosis can develop serious extra-articular complications; intestinal pseudo-obstruction is a very rare gastrointestinal manifestation.