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Plasmacytoma as a cause of small bowel obstruction in a virgin abdomen in a patient with multiple myeloma: a case report.
J Med Case Rep. 2019 May 17; 13(1):148.JM

Abstract

BACKGROUND

Multiple myeloma is a hematological malignancy that classically results in an abnormal clonal proliferation of plasma cells in the bone marrow. Extramedullary disease in the setting of multiple myeloma, referred to as secondary extramedullary plasmacytoma, is found in 7-17% of cases of multiple myeloma at the time of diagnosis and can involve any organ system. Small bowel obstruction is a rare but important gastrointestinal manifestation of multiple myeloma that should be considered in patients with multiple myeloma who present with concerning abdominal symptoms.

CASE PRESENTATION

We present the case of a 52-year-old African-American man with a history of deep venous thrombosis (he is on anticoagulation) and pathologic fracture secondary to multiple myeloma diagnosed 4 months prior to our encounter. He presented with abdominal pain, constipation, nausea, and vomiting. An abdominal X-ray showed distended bowel loops concerning for bowel obstruction and a contrast-enhanced computed tomography scan of his abdomen and pelvis showed a 5.4 cm soft tissue mass involving a loop of distal ileum. He underwent laparoscopic exploration of his abdomen with small bowel resection and primary anastomosis for a small intussusception. He had an uneventful postoperative course and was discharged on postoperative day 6.

CONCLUSIONS

Multiple myeloma has myriad presentations. Gastrointestinal involvement, although rare, can manifest as small bowel obstruction for which early recognition and appropriate surgical management are key to improving outcome. Intussusception is the most common mechanism of obstruction from extramedullary plasmacytoma causing small bowel obstruction and this has been seen in five of six case reports, including this case. It is important to recognize and consider the risks of immunosuppression, venous thromboembolism, and malnutrition in the surgical management of gastrointestinal complications of multiple myeloma.

Authors+Show Affiliations

Department of Surgery, St Agnes Hospital, Baltimore, MD, USA.Department of Surgery, St Agnes Hospital, Baltimore, MD, USA.Department of Surgery, St Agnes Hospital, Baltimore, MD, USA.Colorectal Surgery, St Agnes Hospital, Baltimore, MD, USA.Pancreatic and Hepatobiliary Surgery, St Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore, MD, 21229, USA. Steven.cunningham@ascension.org.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

31097019

Citation

Mwinyogle, Aubrey A., et al. "Plasmacytoma as a Cause of Small Bowel Obstruction in a Virgin Abdomen in a Patient With Multiple Myeloma: a Case Report." Journal of Medical Case Reports, vol. 13, no. 1, 2019, p. 148.
Mwinyogle AA, Bhatt A, Kapisoda K, et al. Plasmacytoma as a cause of small bowel obstruction in a virgin abdomen in a patient with multiple myeloma: a case report. J Med Case Rep. 2019;13(1):148.
Mwinyogle, A. A., Bhatt, A., Kapisoda, K., Somerville, J., & Cunningham, S. C. (2019). Plasmacytoma as a cause of small bowel obstruction in a virgin abdomen in a patient with multiple myeloma: a case report. Journal of Medical Case Reports, 13(1), 148. https://doi.org/10.1186/s13256-019-2068-x
Mwinyogle AA, et al. Plasmacytoma as a Cause of Small Bowel Obstruction in a Virgin Abdomen in a Patient With Multiple Myeloma: a Case Report. J Med Case Rep. 2019 May 17;13(1):148. PubMed PMID: 31097019.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Plasmacytoma as a cause of small bowel obstruction in a virgin abdomen in a patient with multiple myeloma: a case report. AU - Mwinyogle,Aubrey A, AU - Bhatt,Astha, AU - Kapisoda,Katarina, AU - Somerville,Justin, AU - Cunningham,Steven C, Y1 - 2019/05/17/ PY - 2019/02/06/received PY - 2019/04/02/accepted PY - 2019/5/18/entrez PY - 2019/5/18/pubmed PY - 2019/5/18/medline KW - Extramedullary plasmacytoma (EMP) KW - Intussusception KW - Multiple myeloma (MM) KW - Plasmacytoma KW - Small bowel obstruction (SBO) SP - 148 EP - 148 JF - Journal of medical case reports JO - J Med Case Rep VL - 13 IS - 1 N2 - BACKGROUND: Multiple myeloma is a hematological malignancy that classically results in an abnormal clonal proliferation of plasma cells in the bone marrow. Extramedullary disease in the setting of multiple myeloma, referred to as secondary extramedullary plasmacytoma, is found in 7-17% of cases of multiple myeloma at the time of diagnosis and can involve any organ system. Small bowel obstruction is a rare but important gastrointestinal manifestation of multiple myeloma that should be considered in patients with multiple myeloma who present with concerning abdominal symptoms. CASE PRESENTATION: We present the case of a 52-year-old African-American man with a history of deep venous thrombosis (he is on anticoagulation) and pathologic fracture secondary to multiple myeloma diagnosed 4 months prior to our encounter. He presented with abdominal pain, constipation, nausea, and vomiting. An abdominal X-ray showed distended bowel loops concerning for bowel obstruction and a contrast-enhanced computed tomography scan of his abdomen and pelvis showed a 5.4 cm soft tissue mass involving a loop of distal ileum. He underwent laparoscopic exploration of his abdomen with small bowel resection and primary anastomosis for a small intussusception. He had an uneventful postoperative course and was discharged on postoperative day 6. CONCLUSIONS: Multiple myeloma has myriad presentations. Gastrointestinal involvement, although rare, can manifest as small bowel obstruction for which early recognition and appropriate surgical management are key to improving outcome. Intussusception is the most common mechanism of obstruction from extramedullary plasmacytoma causing small bowel obstruction and this has been seen in five of six case reports, including this case. It is important to recognize and consider the risks of immunosuppression, venous thromboembolism, and malnutrition in the surgical management of gastrointestinal complications of multiple myeloma. SN - 1752-1947 UR - https://www.unboundmedicine.com/medline/citation/31097019/Plasmacytoma_as_a_cause_of_small_bowel_obstruction_in_a_virgin_abdomen_in_a_patient_with_multiple_myeloma:_a_case_report_ L2 - https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-019-2068-x DB - PRIME DP - Unbound Medicine ER -