A rare cause of ischemic colitis

Abstract

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.

Ischemic Colitis after Weight-Loss Medication

“…She remains asymptomatic four months later and has not resumed her weight-loss medication. (23,24) Major cardiovascular episode (eg, cardiac failure, shock) (25) Major vascular occlusion (eg, mesenteric venous thrombosis) (26) Vasculitis (eg, systemic lupus erythematosus, polyarteritis nodosa) (27,28) Hypercoagulable state (29) Infection (eg, Escherichia coli O157:H7, cytomegalovirus) (30,31) Prolonged physical exertion (eg, long-distance running) (32) Drugs: estrogen (33), pseudoephedrine (15)(16)(17), methamphetamine (18)(19)(20), cocaine (21,22), nonsteroidal anti-inflammatory drugs (34), aloestron hydrochloride (35)…”

Polyarteritis nodosa: ischaemic intestinal pain successfully treated with nitroglycerin

“…Abdominal pain is a common gastrointestinal symptom in PAN affecting about two-thirds of the patients [1,2]. There are several reports of life-threatening and sometimes fatal involvement of the intestinal arteries [2][3][4]. In the acute phase, however, prednisone and cyclophosphamide treatment are too slow-acting to prevent intestinal infarction.…”

Ischemic Colitis

“…Strictures do not require resection unless there is colonic obstruction, persistent bleed ing or difficulty in differentiating the stric ture from carcinoma [ 18]. The small percent age of cases that persist as a chronic smolder ing colitis are best treated surgically.…”

“…The differential diagnosis of the mild form of ischemic colitis includes acute diver ticulitis, ulcerative colitis, Crohn's disease, carcinoma of the colon, infectious colitis, pseudomembranous colitis, intussusception, volvulus and pancreatitis [9,18,22,40,64]. An important feature of ischemic colitis is the absence of a history of bowel disease in most patients.…”

“…The coli tis followed a gold injection implying an im- mune mediated hypersensitivity reaction. Another example of vasculitis underlying ischemic colitis was reported in a 37-yearold female with systemic lupus erythemato sus in whom mesenteric arteritis and acute and chronic vasculitis of the subserosal vesscls were noted pathologically [ 17], Ischemic colitis that developed secondary to polyar teritis nodosa was reported with involve ment of the mesenteric vasculature [18], and Buerger's disease has been causally related to ischemic colitis [6,9].…”