A woman born in 1920 was since 1997 repeatedly admitted to hospital on account of haemorrhage from the gastrointestinal tract. Melaena was mainly involved, sometimes enterorrhagia. The patient was several times subjected to gastrofibroscopy – always without signs of acute haemorrhage from the upper g-i tract. Rectosco- py revealed only quiescent circular haemorrhoids. On colonoscopic examination in 1997 a polyp was detected. Histology proved that an adenoma was involved with mild to medium dysplastic changes of the glandular epithelium. The polyp was removed endoscopically but the haemorrhage relapsed. Therefore sonography of the gut was made followed by enteroclysis. Because these examinations did not lead to diagnosis, enteroscopy was performed and an exophytically growing jejunal tumour in the area of Treitz’ fossa and multiple ulcerati- ons in the duodenal and jejunal area were found. Histological examination revealed severe amyloidosis at the mentioned sites. Gradually macroglossia developed with histological evidence of amyloid deposits in biopsy from the tongue. The patient had a resection of the duodenum, jejunum apex and anterior two thirds of the tongue. At all sites histological examination confirmed amyloid deposits. Based on the clinical picture, histolo- gical examination and findings in the myelogram and on immunoelectrophoresis, the diagnosis of primary amyloidosis (AL) was established. The condition was complicated by disorders of the cardiac rhythm and acute respiratory insufficiency due to oedema of the tongue. Because food intake by the oral route was impossible gastrostomy was performed. In view of the serious clinical condition of the patient systemic treatment of primary amyloidosis could not be started.

        Key words: primary amyloidosis – haemorrhage into the gastrointestinal tract