Surviving gastrointestinal infarction due to polyarteritis nodosa

A rare event

W. H. Edwards, R. S. Martin, W. H. Edwards, J. L. Mulherin

    Research output: Contribution to journalArticle

    17 Citations (Scopus)

    Abstract

    Poly arteritis nodosa (PAN) is a systemic vasculitis with a male: female ratio of 2:1 and a peak incidence in the fifth decade. Small to medium-sized arteries are involved by focal transmural inflammatory necrosis. Aneurysms with inflammatory destruction of the media also occur. The most frequently involved organs are the kidney, heart, lung, liver, and gastrointestinal tract. There are few reported cases of ischemic necrosis of the intestine and even fewer survivors. A 22-year-old woman was transferred to St. Thomas Hospital (Nashville, TN) after resection of 80 per cent of the small bowel for ischemic necrosis. She had a history of juvenile onset diabetes mellitus, recurrent abdominal pain, and splinter hemorrhages. Emergency aortogram and selective mesenteric arteriogram were performed. The celiac artery was not visualized and small aneurysms were present in the mesenteric and renal arteries. The patient was successfully resuscitated from a cardiac arrest in x ray from a cardiac tamponade. Laparotomy was performed to determine the viability of the bowel. The celiac, hepatic, and splenic arteries were found to be chronically occluded. Pathology of these arteries revealed a nonspecific arteritis. At a third operation, several more inches of small bowel were removed. Characteristic changes of PAN were present on all small bowel specimens. She was treated with high-dose cyclophosphamide and steroids for 6 months and has continued on low-dose cyclophosphamide. She is now 36 months from her original operation and is doing well on oral nutrition. Intestinal hemorrhage from aneurysm rupture or gangrene with perforation are gastrointestinal complications of PAN that the surgeon may be called upon to treat. Immunosuppressive therapy and high-dose steroids remain the only effective treatment of the disease process.

    Original languageEnglish (US)
    Pages (from-to)167-172
    Number of pages6
    JournalAmerican Surgeon
    Volume58
    Issue number3
    StatePublished - Jan 1 1992

    Fingerprint

    Polyarteritis Nodosa
    Arteritis
    Infarction
    Celiac Artery
    Aneurysm
    Necrosis
    Cyclophosphamide
    Arteries
    Steroids
    Hemorrhage
    Splenic Artery
    Systemic Vasculitis
    Cardiac Tamponade
    Mesenteric Arteries
    Gangrene
    Hepatic Artery
    Renal Artery
    Immunosuppressive Agents
    Heart Arrest
    Type 1 Diabetes Mellitus

    All Science Journal Classification (ASJC) codes

    • Surgery

    Cite this

    Edwards, W. H., Martin, R. S., Edwards, W. H., & Mulherin, J. L. (1992). Surviving gastrointestinal infarction due to polyarteritis nodosa: A rare event. American Surgeon, 58(3), 167-172.

    Surviving gastrointestinal infarction due to polyarteritis nodosa : A rare event. / Edwards, W. H.; Martin, R. S.; Edwards, W. H.; Mulherin, J. L.

    In: American Surgeon, Vol. 58, No. 3, 01.01.1992, p. 167-172.

    Research output: Contribution to journalArticle

    Edwards, WH, Martin, RS, Edwards, WH & Mulherin, JL 1992, 'Surviving gastrointestinal infarction due to polyarteritis nodosa: A rare event', American Surgeon, vol. 58, no. 3, pp. 167-172.
    Edwards WH, Martin RS, Edwards WH, Mulherin JL. Surviving gastrointestinal infarction due to polyarteritis nodosa: A rare event. American Surgeon. 1992 Jan 1;58(3):167-172.
    Edwards, W. H. ; Martin, R. S. ; Edwards, W. H. ; Mulherin, J. L. / Surviving gastrointestinal infarction due to polyarteritis nodosa : A rare event. In: American Surgeon. 1992 ; Vol. 58, No. 3. pp. 167-172.
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