Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2015; 21(4): 1324-1328
Published online Jan 28, 2015. doi: 10.3748/wjg.v21.i4.1324
Transanal endoscopic microsurgery: The first attempt in treatment of rectal amyloidoma
Richa Sharma, Virgilio V George
Richa Sharma, Virgilio V George, Department of General Surgery, School of Medicine, Indiana University, Indianapolis, IN 46202, United States
Author contributions: Sharma R and George VV contributed equally to this work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Virgilio V George, MD, Department of General Surgery, School of Medicine, Indiana University, 545 Barnhill Dr, EH 202, Indianapolis, IN 46202, United States. vigeorge@iupui.edu
Telephone: +1-317-2787778 Fax: +1-317-9885323
Received: May 6, 2014
Peer-review started: May 6, 2014
First decision: June 10, 2014
Revised: June 26, 2014
Accepted: August 13, 2014
Article in press: August 28, 2014
Published online: January 28, 2015
Processing time: 266 Days and 7.1 Hours
Abstract

Localized amyloidosis is characterized by amyloid protein deposition restricted to one organ or tissue without systemic involvement. Gastrointestinal manifestations of localized amyloidoma are unusual, which makes amyloidoma restricted to the rectum a very rare diagnosis requiring a high index of suspicion. We present a rare account for rectal amyloidoma with an unusual presentation of obstructive symptoms and its treatment using a sophisticated surgical modality, transanal endoscopic microsurgery (TEM), which resulted in complete excision of the lesion without hospitalization and complications. The successful treatment for this rectal amyloidoma using TEM emphasizes the need to broaden its application in the treatment of various rectal lesions while preserving organ function and decreasing recurrence.

Keywords: Transanal endoscopic microsurgery; Transanal endoscopic microsurgery; Amyloidoma; Localized amyloidosis; Rectal amyloidoma

Core tip: This case represents the first transanal endoscopic microsurgery (TEM) approach for full-thickness excision to treat organ restricted amyloidosis of the rectum, a very rare entity requiring high suspicion for diagnosis and treatment. Although TEM is the preferred modality to treat early rectal cancers and rectal adenomas, it should also be considered for other benign and non-advanced rectal lesions, such as localized amyloidoma. TEM is a less invasive procedure that provides lower morbidity and mortality by decreasing incidence of local recurrence and complications while preserving rectal continence and function.