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A rare cause of ischemic colitis: Polyarteritis nodosa

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Diseases of the Colon & Rectum

Summary

This paper details the first case report of a patient with fulminant, gangrenous, ischemic colitis caused by polyarteritis nodosa which was successfully treated surgically.

Ischemic colitis is a rare complication of polyarteritis nodosa. It should be suspected in patients with a past history of polyarteritis nodosa who develop abdominal pain and rectal bleeding. The identification of cutaneous lesions preoperatively and or mesenteric or serosal vascular beading at operation are helpful in establishing this diagnosis. Prognosis is generally determined by the extent of systemic involvement by polyarteritis nodosa, and death is generally associated with renal failure.

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References

  1. Akbarian M: Abdominal apoplexy in polyarteritis nodosa: Report of a case. Am J Dig Dis 11: 63. 1966

    Article  PubMed  CAS  Google Scholar 

  2. Allen PD: Periarteritis nodosa simulating an, acute abdominal condition requiring operation. Arch Surg 40: 271, 1940

    Google Scholar 

  3. Arkin A: A clinical and pathological study of periarteritis nodosa: A report of five cases, one histologically healed. Am J Pathol 6: 401, 1930

    CAS  PubMed  Google Scholar 

  4. Bohrod MG: Surgical implications of the connective tissue diseases. J Int Coll Surg 36: 285, 1961

    Google Scholar 

  5. Boley SJ, Brandt LJ, Veith FJ: Ischemic disorders of the intestines. Curr Probl Surg 15: 1 (Apr) 1978

    Article  PubMed  CAS  Google Scholar 

  6. Borrie P: Cutaneous polyarteritis nodosa. Br J Dermatol 87: 87, 1972

    Article  PubMed  CAS  Google Scholar 

  7. Boyd LJ: Periarteritis nodosa: Abdominal manifestations. Bull NY Med Coll Flower Fifth Ave Hosps 4: 27, 1941

    Google Scholar 

  8. Brown HW Jr, Ghosh S: Polyarteritis nodosa presenting as an acute abdomen. Int Surg 51: 30, 1969

    PubMed  Google Scholar 

  9. Bulger TJ: Periarteritis nodosa: A case requiring surgery, with a review of the literature. Del State Med J 19: 59, 1947

    CAS  Google Scholar 

  10. Buranasiri S, Baum S, Nusbaum M, et al: Periarteritis of the middle colic artery: Arteriographic, surgical and pathological correlation. Am J Gastroenterol 59: 73, 1973

    PubMed  CAS  Google Scholar 

  11. Cabal E, Holtz S: Polyarteritis as a cause of intestinal hemorrhage. Gastroenterology 61: 99 1971

    PubMed  CAS  Google Scholar 

  12. Campbell RE: Abdominal signs and symptoms of periarteritis nodosa. Med. Bull US Army Europe 11: 164, 1954

    PubMed  CAS  Google Scholar 

  13. Carron DB, Douglas AP: Steatorrhoea in vascular insufficiency of the small intestine: Five cases of polyarteritis nodosa and allied disorders. Q J Med 34: 331, 1965

    PubMed  CAS  Google Scholar 

  14. Case Records of the Massachusetts General Hospital: Case 63-1963. N Engl J Med 267: 663, 1962

    Article  Google Scholar 

  15. Case Records of the Massachusetts General Hospital: Case 14-1963. N Engl J Med 268: 438, 1963

    Article  Google Scholar 

  16. Cowan RE, Millinson CN, Thomas GE, et al: Polyarteritis nodosa of the liver: A report of two cases. Postgrad Med J 53: 89, 1977

    PubMed  CAS  Google Scholar 

  17. Craig RD: Multiple perforations of small intestine in poly-arteritis nodosa. Gastroenterology 44: 355 1963

    PubMed  CAS  Google Scholar 

  18. Crawford T: Polyarteritis nodosa, Pathology, Ed 7. Edited by WA Anderson, JM Kissane. St Louis, C. V. Mosby, 1977, vol 1, p. 900

    Google Scholar 

  19. Dahl EV, Baggenstoss AH, DeWeerd JH: Testicular lesions of periarteritis nodosa, with special reference to diagnosis. Am J Med 28: 222, 1960

    Article  PubMed  CAS  Google Scholar 

  20. Diaz-Perez JL, Winkelmann RK: Cutaneous periarteritis nodosa. Arch Dermatol 110: 407, 1974

    Article  PubMed  CAS  Google Scholar 

  21. Donnelly GH, Campbell RE: Surgical aspects of periarteritis nodosa. Arch Surg 69: 533, 1954

    CAS  Google Scholar 

  22. Evens RG, Dobry CA, Eckert JF: Case of the month from the AFIP: An exercise in radiologic-pathologic correlation. Radiology 91: 1028, 1968

    PubMed  CAS  Google Scholar 

  23. Fauci AS, Haynes BF, Katz P: The spectrum of vasculitis: Clinical, pathologic, immunologic, and therapeutic considerations. Ann Intern Med 89: 660, 1978

    PubMed  CAS  Google Scholar 

  24. Fayemi AO, Ali M, Braun EV: Necrotizing vasculitis of the gallbladder and the appendix: Similarity in the morphology of rheumatoid arteritis and polyarteritis nodosa. Am J Gastroenterol 67: 608, 1977

    PubMed  CAS  Google Scholar 

  25. Felsen J: The sigmoidoscopic diagnosis of periarteritis nodosa. Ann Intern Med 15: 251, 1941

    Google Scholar 

  26. Finkbiner RB, Decker JP: Ulceration and perforation of the intestine due to necrotizing arteriolitis. N Engl J Med 268: 14, 1963

    Article  Google Scholar 

  27. Finkelstein W, Brennan PJ: Periarteritis nodosa: Brief review and case report. Conn State Med J 7: 104, 1943

    Google Scholar 

  28. Furst SE, Dowling EA: Intra-abdominal hemorrhage due to polyarteritis nodosa: Report of a patient. South Med J 56: 454, 1963

    PubMed  CAS  Google Scholar 

  29. Gallagher HW, Hanna WA: Polyarteritis presenting as acute appendicitis. J R Coll Surg Edinb 9: 294, 1963-64

    Google Scholar 

  30. Gourgoutis GD, Paguirigan AA, Berzins T: Gastric perforation in polyarteritis nodosa: Report of a patient. Am J Dig Dis 16: 171, 1971

    Article  PubMed  CAS  Google Scholar 

  31. Hagihara PF, Parker JC, Griffen WO Jr: Spontaneous ischemic colitis. Dis Colon Rectum 20: 236, 1977

    PubMed  CAS  Google Scholar 

  32. Harris AW, Lynch GW, O'Hare JP: Periarteritis nodosa. Arch Intern Med 63: 1163, 1939

    Google Scholar 

  33. Hay JM, Testart J: Périartérite noueuse, et perforation colique. J Chir (Paris) 107: 313, 1974

    CAS  Google Scholar 

  34. Hunsicker RC, James PM Jr: Intestinal polyarteritis nodosa: A surgical impasse? South Med J 65: 337, 1972

    PubMed  CAS  Google Scholar 

  35. Jernstrom P, Stasney J: Acute ulcerative enteritis due to poly-arteritis: A diagnostic dilemma. JAMA 148: 544, 1952

    CAS  Google Scholar 

  36. Johnson CC, Baggenstoss AH: Mesenteric vascular occlusion: II. Study of 60 cases of occlusion of arteries and of 12 cases of occlusion of both arteries and veins. Mayo Clin Proc 24: 649, 1949

    PubMed  CAS  Google Scholar 

  37. Joyce TM, Menne FR, Smith GK: The surgical aspects of peri-arteritis acuta nodosa. Trans West Surg Assoc 49: 208, 1939

    Google Scholar 

  38. Ketron LW, Bernstein JC: Cutaneous manifestations of periarteritis nodosa. Arch Dermatol Syph 40: 929, 1939

    Google Scholar 

  39. Keys RC: Polyarteritis nodosa in the acute abdomen. J R Coll Surg Edinb 21: 341, 1976

    PubMed  CAS  Google Scholar 

  40. King BG: The clinical diagnosis of periarteritis nodosa: Report of four cases. Ann Intern Med 32: 466, 1950

    Google Scholar 

  41. Lee HC, Kay S: Primary polyarteritis nodosa of the stomach and small intestine as a cause of gastro-intestinal hemorrhage. Ann Surg 147: 714, 1958

    Article  PubMed  CAS  Google Scholar 

  42. Levin MH, Rivo JB, Scott W et al: The prolonged treatment of rheumatoid arthritis with cortisone and corticotropin. Am J Med 14: 265, 1953

    Article  PubMed  CAS  Google Scholar 

  43. Logue RB, Mullins F: Polyarteritis nodosa: Report of 11 cases with review of recent literature. Ann Intern Med 24: 11, 1946

    Google Scholar 

  44. Lowenstein PS, Heeb MA: Intestinal obstruction secondary to periarteritis nodosa. Angiology 6: 417, 1955

    PubMed  CAS  Google Scholar 

  45. Marcuson RW: Ischaemic colitis. Clin Gastroenterol 1: 745, 1972

    Google Scholar 

  46. Marston A, Pheils MT, Thomas ML et al: Ischaemic colitis. Gut 7: 1, 1966

    PubMed  CAS  Google Scholar 

  47. Martin LW, Landing BH, Nakai H: Rectal biopsy as an aid in the diagnosis of diseases of infants and children. J Pediatr 62: 197, 1963

    Article  Google Scholar 

  48. Maxeiner SR Jr, McDonald JR, Kirklin JW: Muscle biopsy in the diagnosis of periarteritis nodosa: An evaluation. Surg Clin North Am 32: 1225 (Aug) 1952

    Google Scholar 

  49. McKeown KC, Ganguli AK: Gastro-intestinal symptoms in polyarteritis nodosa: Report of a case. Br J Surg 44: 308, 1956

    Article  PubMed  Google Scholar 

  50. Nightingale EJ: The gastroenterological aspects of periarteritis nodosa. Am J Gastroenterol 31: 152, 1959

    PubMed  CAS  Google Scholar 

  51. Norman AG, Wilkins PS: Abdominal periarteritis nodosa. Br MED J 1: 445, 1957

    Article  PubMed  CAS  Google Scholar 

  52. Nygaard K, Flatmark A: Mesenteric arteritis with extensive intestinal gangrene. Acta Chir Scand 139: 470, 1973

    PubMed  CAS  Google Scholar 

  53. Painter RW: Sequential gastrointestinal complications ofpolyarteritis nodosa. Am J Gastroenterol 55: 383, 1971

    PubMed  CAS  Google Scholar 

  54. Parker RA, Thomas PM: Intestinal perforation and wide-spread arteritis in rheumatoid arthritis during treatment with cortisone. Br Med J 1: 540, 1959

    PubMed  CAS  Google Scholar 

  55. Patalano VJ, Sommers SC: Biopsy diagnosis of periarteritis nodosa: Glomerulonephritis and renal arteriolitis as aids. Arch Pathol 72: 1, 1961

    PubMed  CAS  Google Scholar 

  56. Pugh JI, Stringer P: Abdominal periarteritis nodosa. Br J Surg 44: 302, 1956

    Article  PubMed  CAS  Google Scholar 

  57. Rabinovitch J, Rabinovitch S: Infarction of the small intestine sequent to polyarteritis nodosa of the mesenteric vessels. Am J Surg 88: 896, 1954

    Article  PubMed  CAS  Google Scholar 

  58. Robbins SL: Polyarteritis nodosa (periarteritis nodosa, panarteritis nodosa), Pathologic Basis of Disease. Philadelphia, W B Saunders, 1974, p 236

    Google Scholar 

  59. Rosenblum WI, Budzilovich GN, Solomon C: Periarteritis nodosa with perforation of the colon: A rare complication; report of 2 cases. Am J Dig Dis 8: 463, 1963

    Article  Google Scholar 

  60. Rosenmann E, Levij IS: Rectal biopsy as a diagnostic aid in periarteritis nodosa. Isr J Med Sci 7: 1082, 1971

    PubMed  CAS  Google Scholar 

  61. Schneider RE, Dobbins WO III: Suction biopsy of the rectal mucosa for diagnosis of arteritis in rheumatoid arthritis and related disease. Ann Intern Med 68: 561, 1968

    PubMed  CAS  Google Scholar 

  62. Singer HA: Periarteritis nodosa: With special reference to the acute abdominal manifestations: Report of two cases. Arch Intern Med 39: 865, 1927

    Google Scholar 

  63. Smith WR: Abdominal visceral periarteritis nodosa. West J Surg Obstet Gynecol 66: 12, 1958

    PubMed  CAS  Google Scholar 

  64. Spalding JE: Periarteritis nodosa and its surgical significance: Report of a case. Guys Hosp Rep 90: 234, 1940-41

    Google Scholar 

  65. Spiegel R: Clinical aspects of periarteritis nodosa. Arch Intern Med 58: 993, 1936

    Google Scholar 

  66. Wold LE, Baggenstoss AH: Gastrointestinal lesions of periarteritis nodosa. Mayo Clin Proc 24: 28, 1949

    PubMed  CAS  Google Scholar 

  67. Woods AC Jr, Parry RG, Detmer DE: Successful surgical treatment of massive abdominal hemorrhage due to periarteritis nodosa. Arch Surg 97: 541, 1968

    PubMed  Google Scholar 

  68. Zimmerman HJ, Kleitsch WP, Greene AM, et al: Periarteritis (polyarteritis) nodosa producing intussusception: Report of two cases. Arch Intern Med 94: 264, 1954

    CAS  Google Scholar 

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Authors and Affiliations

  1. Departments of Surgery and Pathology, Cook County Hospital, Chicago, Illinois

    Michael K. Wood M.D., Don R. Read M.D.,  Avram R. Kraft M.D. & Telly M. Barreta M.D.

  2. Department of Surgery, The Abraham Lincoln School of Medicine, University of Illinois at the Medical Center, Chicago, Illinois

    Michael K. Wood M.D., Don R. Read M.D.,  Avram R. Kraft M.D. & Telly M. Barreta M.D.

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  1. Michael K. Wood M.D.
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  2. Don R. Read M.D.
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  3. Avram R. Kraft M.D.
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  4. Telly M. Barreta M.D.
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Wood, M.K., Read, D.R., Kraft, A.R. et al. A rare cause of ischemic colitis: Polyarteritis nodosa. Dis Colon Rectum 22, 428–433 (1979). https://doi.org/10.1007/BF02586919

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  • DOI: https://doi.org/10.1007/BF02586919

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