# Bowel Blockage Without a Block: Amyloidosis Presenting as Chronic Intestinal Pseudo-Obstruction

## TL;DR

A man with chronic intestinal symptoms was diagnosed with amyloidosis after multiple surgeries and tests failed to find a cause.

## Contribution

This case highlights amyloidosis as a rare but important cause of chronic intestinal pseudo-obstruction.

## Key findings

- Chronic intestinal pseudo-obstruction was suspected after multiple surgeries failed to identify a cause.
- Amyloidosis was confirmed via abdominal fat pad biopsy with Congo red staining.
- The patient's symptoms partially improved with prucalopride but still require parenteral nutrition and a gastrostomy tube.

## Abstract

We present the case of a 61-year-old man with a history of schizophrenia and non-ischemic cardiomyopathy who was admitted with chronic nausea, vomiting, and abdominal pain. His clinical course was marked by recurrent hospitalizations due to persistently dilated small bowel and multiple exploratory laparotomies, all failing to yield a definitive diagnosis, raising suspicion for chronic intestinal pseudo-obstruction. Extensive testing for vascular, paraneoplastic, infectious, and autoimmune causes was unremarkable. Given his unexplained cardiomyopathy and elevated serum light chains with a mild M spike, amyloidosis was suspected. A biopsy of the abdominal fat pad with Congo red staining confirmed amyloid deposition. His symptoms showed partial improvement with prucalopride, but he continues to require total parenteral nutrition and a venting gastrostomy tube for symptom management. Amyloid subtyping and a bone marrow biopsy are pending to determine the underlying etiology.