A huge fecalith associated with dialysis-related gastrointestinal amyloidosis.
A 60-year-old man who had been receiving dialysis for more than 30 years was admitted for treatment of cellulitis in his right thigh on November 7, 2003. He suffered from an ileus on December 14 and was found to have a huge, 7-cm-diameter, well-circumscribed fecalith, incarcerated at the splenic flexure of the colon. It was proving difficult to pass this naturally and surgical removal was thought to be too risky. Using a colonoscope and a water-jet probe, the fecalith was broken up; the ileus then improved and the patient was able to take oral fluids. Unfortunately, he died of cardiac failure on February 13, 2004. We conducted an autopsy, with his family's consent, and found generalized amyloidosis. Deposits of amyloid were seen in all layers of the colon. Because of this, we hypothesized that peristalsis had been poor and this had led to paralytic ileus due to stasis, which, in turn, had led to the formation of the huge fecalith. In Japan it is not rare for a patient to be on dialysis for more than 25 years and it may be that this is a cause of generalized amyloidosis. There have been no such cases of fecalith associated with gastrointestinal amyloidosis described previously, which is why we decided to report this case here.
Ono
Takashi
T
Kidney Center, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuou-ku, Fukuoka, 810-0001, Japan. taka-ono@yf6.so-net.ne.jp.
Narikiyo
Takefumi
T
Kidney Center, Saiseikai Yahata Hospital, Kitakyushu, Japan.
Nishida
Eiichi
E
Kidney Center, Saiseikai Yahata Hospital, Kitakyushu, Japan.
Yanagida
Taihei
T
Kidney Center, Saiseikai Yahata Hospital, Kitakyushu, Japan.
Yasunaga
Chikao
C
Kidney Center, Saiseikai Yahata Hospital, Kitakyushu, Japan.
Hisaoka
Masanori
M
Department of Pathology and Oncology, University of Occupational and Environmental Health, Kitakyushu, Japan.
Sakino
Ikuo
I
Department of Radiology, Saiseikai Yahata Hospital, Kitakyushu, Japan.
Osamura
Shunji
S
Digestive Tract Internal Medicine, Saiseikai Yahata Hospital, Kitakyushu, Japan.
Nakamoto
Masahiko
M
Kidney Center, Saiseikai Yahata Hospital, Kitakyushu, Japan.
D000682:Amyloid / Q000378:metabolism; D000686:Amyloidosis / Q000150:complications* / Q000209:etiology; D003106:Colon / Q000378:metabolism / Q000473:pathology; D005244:Fecal Impaction / Q000175:diagnosis / Q000209:etiology*; D005767:Gastrointestinal Diseases / Q000150:complications* / Q000209:etiology; D005921:Glomerulonephritis / Q000628:therapy; D006801:Humans; D007418:Intestinal Pseudo-Obstruction / Q000150:complications / Q000209:etiology; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*
D000682:Amyloid