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Recurrent spontaneous small bowel perforations with a rare pathology: non-familial visceral myopathy
  1. Meiyi Shi1,
  2. Young Mee Choi2 and
  3. Elizabeth Kiselak1
  1. 1Department of Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
  2. 2Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  1. Correspondence to Dr Meiyi Shi; meiyi.shi{at}hmhn.org

Abstract

Visceral myopathy is a rare, often misdiagnosed disease characterised by abnormalities in the gastrointestinal smooth muscle layer. Its clinical presentation includes pseudo-obstruction, intestinal dysmotility and spontaneous perforation. We report an atypical case of a 51-year-old man with a history of recurrent small bowel perforations who presented with an acute abdomen. A laparotomy was performed with identification of a distal jejunal perforation. A small bowel resection with end-to-end anastomosis was done. Minimal adhesions were seen intraoperatively despite the patient’s multiple prior surgeries. Pathology showed histiocytic inflammation and patchy loss of the muscle layer reflective of visceral myopathy. Genetic testing revealed a variant of uncertain significance in the myosin light chain kinase gene. It is difficult to make a conclusive diagnosis given the patient’s clinical presentation closely mimicking other gastrointestinal disorders. However, it is crucial to consider visceral myopathy in patients with recurrent spontaneous intestinal perforations as a differential diagnosis.

  • general surgery
  • gas/free gas
  • small intestine

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  • Contributors All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing or revision of the manuscript. Furthermore, each author certifies that this material or similar material has not been and will not be submitted to or published in any other publication before its appearance in the BMJ Case Report.Conception and design of study: MS, YMC, EK. Acquisition/analysis/interpretation of data: MS, YMC, EK. Drafting and revision of manuscript: MS, YMC, EK. Approval of final version to be published: MS, YMC, EK. Agreement to be accountable for all aspects of the work: MS, YMC and EK.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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