A Rare Case of Ascites due to Peritoneal Amyloidosis

Systemic AA amyloidosis with amyloid deposition in the peritoneum at the time of initiating peritoneal dialysis

Amyloidosis is characterized by the deposition of insoluble amyloid fibrils formed by disease-specific precursor proteins in the extracellular interstitium of various organs throughout the body, resulting in organ damage. Patients with amyloidosis often develop end-stage kidney disease (ESKD), which can be managed with dialysis or kidney transplantation. Peritoneal dialysis (PD) is advantageous over hemodialysis (HD) in managing the circulatory dynamics and removing the precursor proteins of amyloid fibrils. However, the clinical course of PD using an amyloid-deposited peritoneum has not been reported. In this paper, we describe a rare case of systemic AA amyloidosis with amyloid deposition in the peritoneum at the beginning of PD. The peritoneal equilibrium test (PET) at PD initiation revealed a high transport rate. The dialysis solution was temporarily changed to a high-glucose concentration peritoneal dialysate, and a weekly extracorporeal ultrafiltration method was added. The patient continued with PD treatment without any complications. The PET category changed from "high" to "high average" during the subsequent PD treatment course. The serum amyloid A levels improved post-nephrectomy and remained in the normal range. Amyloid A was not detected in the dialysate drainage. In conclusion, the amyloid-deposited peritoneum has no uniform effect on the clinical course of PD. Moreover, amyloidosis therapy can alter the peritoneal function with amyloid deposition. However, future studies should investigate the exact mechanism of the alteration of peritoneal function with amyloidosis therapy.

Peritoneal Amyloid as a Presenting Manifestation of AL Amyloid

Amyloid is a systemic disease characterized by extracellular deposition of misfolded protein. Gastrointestinal and peritoneal deposition of light chain (AL) amyloid is an under-recognized manifestation of this systemic disease, usually as a late sequela. Here we present a case of recently diagnosed AL peritoneal amyloid that presented in the context of recurrent, acute onset abdominal discomfort and was found to have bowel obstruction complicated by perforation in the setting of AL-mediated gastrointestinal tract infiltration and dysmotility.

Non-neoplastic conditions mimicking peritoneal carcinomatosis at CT imaging

The general appearance of peritoneal carcinomatosis at abdominal CT and other cross-sectional imaging modalities consists of varying amounts of peritoneal-based soft tissue implants (mass-forming or infiltrative), peritoneal fluid, and occasionally calcification. However, a wide variety of common and uncommon neoplastic and non-neoplastic conditions can closely mimic peritoneal carcinomatosis at imaging. Neoplastic mimics of peritoneal carcinomatosis include primary peritoneal and sub peritoneal tumors, as well as peritoneal lymphomatosis and sarcomatosis.Broad categories of non-neoplastic mimics of peritoneal carcinomatosis include tumor-like conditions, systemic processes, atypical infections, and fat-based conditions. For many entities, suggestive or specific patient information and/or CT imaging findings exist that may allow the radiologist to narrow the differential diagnosis. In this article, we review the salient clinical and cross-sectional imaging features of non-neoplastic mimics of peritoneal carcinomatosis and malignancy, with emphasis on the CT findings and the additional clues that may suggest the correct benign diagnosis.

Upper Gastrointestinal Manifestation of Bezoars and the Etiological Factors: A Literature Review

A gastric bezoar is a compact mass of indigestible foreign materials that accumulate and consolidate in the stomach; however, it can be found in other sites of the gastrointestinal tract. The causative manner of this condition is complex and multifactorial. The main purpose of the review was to raise awareness among clinicians, particularly gastroenterologists, that patients with certain risk factors or comorbid conditions are predisposed to gastric bezoar formation. Early diagnosis and prompt intervention are crucial to avoid bezoar-induced complications. Upper gastrointestinal endoscopy is the standard diagnostic and therapeutic method for gastric bezoars. However, for large size bezoars, surgical intervention is needed.

A rare case of omental cake

Systemic amyloidosis is normally detected on histology by deposition of amyloid into soft tissue organs. Omental and peritoneal involvement are rare manifestations of the disease. The differential diagnosis for omental and peritoneal disease does not, therefore, normally include amyloid.

Gastrointestinal amyloidosis: A case report and literature review

Gastrointestinal amyloidosis is a rare clinical entity. Here we report such a case in a 64-year-old woman who presented with periumbilical pain for half a year. Endoscopic examination revealed multiple red or yellow elevations in the gastrointestinal mucosa. Pathological biopsy revealed chronic mucosal inflammation with amyloidosis of the lamina propria. Congo red staining yielded a positive result. The patient was finally diagnosed with gastrointestinal amyloidosis.