W. Keywords: Wipple��s Disease, Tropheryma Whipplei, Surgical treatment, Ileostomy Introduction The Wipple��s Disease (W.D.) is a multisystemic chronic infectious disease, very rare, with an annual incidence of 1 per 1.000.000 inhabitants (1) affecting mainly male patients 40�C50 years old (2), described by Wipple for the first time in 1907 (3). The etiology was attributed sellckchem to Gram-positive Actinomycete namely the Tropheryma Whipplei (T.W.) observed and identified 100 years after description of the disease, when the rod-shaped organisms were observed inside the macrophages and in the cytoplasm vacuoles of various cellular elements, such as those of the duodenal mucosa and other tissues (4�C6). The symptoms of W.D.

are multisystemic with initial predominant involvement of the joints followed by, or concurrent with, the involvement of gastrointestinal system with onset of diarrhea, weight loss and malabsorption (7). W.D. can sometimes also affect the myocardial cells with endocarditis (8), or associated with different neurological symptoms, accompanied by psychic disturbances. Prolonged antibiotic treatment with Trimethoprim and Sulfomethoxazole continuously for 1�C2 years guarantees the remission of the disease and prevents relapse (9). The Authors describe a rare case of W.D. treated with emergency surgical procedure for bowel obstruction and perforation. Case report P.D. a 56 years old woman admitted for emergency bowel obstruction with severe cachexia, malabsorption and dilated cardiomyopathy, associated with cyclic bloodstained diarrhoea, with weight loss and psychiatric disorders.

Her medical history revealed a previous hospitalization for deep vein thrombosis (DVT) of the left leg, while the CT of the abdomen showed edema with thickening of the intestinal wall with swelling at the level of ileus. Following the worsening of malabsorption with accentuated organic decay, the patient was subjected to further CT scan which confirmed thickening of the intestinal wall of the small intestine, while PET noted a diffuse accumulation of the radioisotope on the intestinal wall, particularly in the small pelvis. The CT performed during emergency hospitalization in our Department showed a diffuse dilatation of the entire small intestine, with numerous levels and gastrectasia associated to mesenteric lymphadenopathy and thickened intestinal loops.

Exploratory laparotomy confirmed the intestinal obstruction and concomitant suppurative peritonitis, with thickened bowel loops conglomerated and widespread edema of the mesentery. In relation to the clinical AV-951 conditions and the running peritonitis, an ileostomy and biopsy of the wall of intestine and of lymph nodes were performed, which histologically showed numerous macrophages, with intracellular PAS-positive material. Given these findings, the diagnosis of W.D. was assumed.