SHM Converge Scientific Abstract ePoster Gallery-Aggressive Extramedullary Multiple Myeloma Presenting as a Small Bowel Obstruction

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A 58-year-old woman presented with abdominal pain, nausea, oral intolerance, a distended abdomen, left lower quadrant tenderness, and absent bowel sounds. She was hemodynamically stable but had microcytic anemia consistent with iron deficiency (hemoglobin 8.1). Abdominal X-ray showed distended bowel loops, and CT demonstrated enteroenteric intussusception with an intraluminal soft tissue mass causing small bowel obstruction.<br /><br />Initial differential diagnosis included primary malignancy, metastatic disease, and a submucosal lesion such as a gastrointestinal stromal tumor. She received supportive care with nasogastric decompression and underwent exploratory laparoscopy with mass resection. Surgical oncology was involved intraoperatively after the mass was identified. Histopathology revealed a high-grade plasma cell neoplasm, concerning for extramedullary multiple myeloma (EMM), and oncology was consulted.<br /><br />Subsequent PET/CT imaging showed additional FDG-avid extramedullary sites, including the left posterior 4th rib, right posterior thoracic tissues, and left greater trochanter, as well as uptake in the small bowel and urinary system. Contrasted CT confirmed left lower quadrant intussusception with upstream SBO and identified the soft tissue mass acting as the lead point.<br /><br />Key teaching points: hospitalists should consider unusual causes of common presentations like bowel obstruction. EMM can involve soft tissue or organs without classic multiple myeloma findings and is more aggressive than typical MM. Advanced imaging such as PET-CT is important for detecting disease extent, and early multidisciplinary consultation is essential for timely diagnosis and management.

Asset Subtitle

Paul Wurtz

Meta Tag

Author List Kristin Stoll, Paul Wurtz

Category Clinical Vignettes

Concept Extramedullary Multiple Myeloma

Concept Small Bowel Obstruction

Concept Plasma Cell Disorder

Concept Intussusception

Concept Computed Tomography

Distinguished Non-Finalist

Presenter Organization Brooke Army Medical Center

Presenting Author Paul Wurtz

Track Adult

Keywords

abdominal pain

small bowel obstruction

intussusception

extramedullary multiple myeloma

plasma cell neoplasm

iron deficiency anemia

CT imaging

PET-CT

surgical resection

multidisciplinary consultation

Extramedullary Multiple Myeloma

Small Bowel Obstruction

Plasma Cell Disorder

Intussusception

Computed Tomography