SUMMARY The occurrence of clinical manifestations of mechanical intestinal obstruction in eight cases of systemic amyloidosis is reported. Seven similar cases have been recorded in the literature and are briefly reviewed. Correct diagnosis is important in these cases if useless surgical treatment or prolonged diagnostic investigations are to be avoided. Gastrointestinal involvement by systemic amyloidosis should be considered in a patient presenting with clinical manifestations of mechanical obstruction but paralytic ileus seen on plain films. In these cases an attempt should be made, by means of a barium enema, to exclude an obstructing lesion of the colon or distal small bowel. Once amyloidosis is considered, it can be confirmed easily and safely by biopsy of the rectal or small-intestinal mucosa.Intestinal pseudo-obstruction has been defined by Stephens (1962) as the occurrence of clinical manifestations of mechanical obstruction of the intestine with no organic occlusion of the lumen. This syndrome has seldom been reported as occurring secondarily to amyloid infiltration of the gastrointestinal tract, yet it not infrequently complicates the course of systemic amyloidosis. In a review of 121 proved cases of systemic amyloidosis at the Mayo Clinic, we encountered eight in which clinical manifestations of mechanical obstruction of the intestine developed during the illnesses. Recognition of this condition is important in order to avoid surgical treatment which would be ineffectual and which is associated with a high mortality and dangerous complications. Report of an Illustrative CaseA 55-year-old white man came to the Mayo Clinic complaining of shortness of breath and generalized weakness of five months' duration. A diagnosis of multiple myeloma had been made elsewhere at the onset of these symptoms. ForReceived for publication 2 February 1970. two months he complained of increasing constipation and intermittent, crampy, abdominal pain and distension, aggravated by the ingestion of food.When he was admitted gaseous distension of the abdomen was noted. Four days later there was an increase in abdominal distension, associated with crampy abdominal pain; bowel sounds were noted to be high-pitched. A plain radiograph of the abdomen revealed gaseous distension of the colon as far as the splenic flexure but with no gas distal to this (Fig. 1). A barium enema study was not obtained. However, a presumptive diagnosis of carcinoma of the splenic flexure of the colon was made.A brief attempt at decompression by enemas and nasogastric suction was not effective, so emergency surgery was undertaken. Transverse loop colostomy was performed, but the patient died the following day. At necropsy the diagnosis of multiple myeloma was confirmed, and amyloid was found deposited in the heart and in the entire gastrointestinal tract. The amyloid was scattered in the circular and longitudinal muscle layers of the intestines and was particularly heavy at the splenic flexure of the colon. The large bowel was distended up to this segm...

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