SHM Converge Scientific Abstract ePoster Gallery-A Gut Motility Mystery: A Unique Presentation of Systemic Amyloidosis

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This case describes a 61-year-old man with HFrEF, hypertension, and schizoaffective disorder who was transferred for management of recurrent abdominal pain and suspected small bowel obstruction. He had persistent pain, nausea, vomiting, abdominal distension, and bilateral leg edema. Exam showed diffuse abdominal tenderness, and CT imaging demonstrated dilated proximal and mid small bowel with decompressed distal ileum, but no clear transition point, suggesting obstruction without an obvious mechanical cause. An initial exploratory laparotomy at an outside hospital did not show ischemic bowel.<br /><br />Because he also had unexplained non-ischemic cardiomyopathy and severe gastrointestinal dysmotility, the team considered a systemic infiltrative disorder such as amyloidosis. The diagnostic work-up was broad, including autoimmune, paraneoplastic, and neurologic testing. SPEP showed a small M-spike, and an abdominal fat pad biopsy confirmed amyloidosis with Congo red positivity and apple-green birefringence.<br /><br />The discussion emphasizes that amyloid can affect the gastrointestinal tract by infiltrating the enteric nervous system, vascular supply, and smooth muscle, leading to dysmotility, gastroparesis, or pseudo-obstruction. Although GI involvement occurs in a minority of systemic amyloidosis cases, it should be considered when bowel symptoms coexist with otherwise unexplained cardiomyopathy. Abdominal fat pad biopsy is highlighted as a minimally invasive test with high specificity for systemic amyloidosis. Prognosis is especially guarded when the heart is involved.<br /><br />Management focused on treating the presumed bowel obstruction, supporting heart failure, and reducing factors that may worsen motility. He received diuresis, guideline-directed medical therapy, nasogastric decompression, motility agents, and minimization of anticholinergic antipsychotic burden. Later diagnostic laparoscopy found only minor non-obstructing adhesions and absent peristalsis, supporting a functional motility disorder rather than a fixed mechanical obstruction.

Asset Subtitle

Shreya Sridhara

Meta Tag

Author List Hannah C. Matthews, Rahul Sandella, MD, Shannon K. Martin, Shreya Sridhara

Category Clinical Vignettes

Concept Systemic Amyloidosis

Concept Gastrointestinal Dysmotility

Concept Small Bowel Obstruction

Concept Diabetic Gastroparesis

Concept Congo Red Staining

Distinguished Non-Finalist

Presenter Organization University of Chicago Pritzker School of Medicine

Presenting Author Shreya Sridhara

Track Adult

Keywords

amyloidosis

small bowel obstruction

gastrointestinal dysmotility

non-ischemic cardiomyopathy

HFrEF

abdominal fat pad biopsy

Congo red positivity

pseudo-obstruction

enteric nervous system infiltration

abdominal distension

Systemic Amyloidosis

Gastrointestinal Dysmotility

Small Bowel Obstruction

Diabetic Gastroparesis

Congo Red Staining