Perforation of the sigmoid colon with ischemic change due to polyarteritis nodosa

Okada, Masaki; Konishi, Fumio; Sakuma, Kazuya; Kanazawa, Kyotaro; Koiwai, Hirobumi; Kaizaki, Yasuharu

doi:10.1007/s005350050283

Cited by 23 publications

(24 citation statements)

References 6 publications

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“…A few patients with PAN or MPA who developed colonic perforation have also been reported. 20,29,30 Our patient did not have an intestinal perforation; however, this possibility should always be considered when patients with PAN or MPA present with abdominal pain or gastrointestinal bleeding.…”

Section: Discussionmentioning

confidence: 89%

Microscopic polyangiitis complicated with massive intestinal bleeding

Ueda¹,

Matsumoto²,

Ahn³

et al. 2001

Journal of Gastroenterology

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Microscopic polyangiitis (MPA) is associated with renal dysfunction, in most cases, and occasionally with pulmonary hemorrhage. However, massive intestinal bleeding is a rare manifestation. We report a case of MPA in a man who developed arterial bleeding in the small intestine. A 74-year-old man was admitted after enduring a fever for 4 weeks. Laboratory examination revealed leucocytosis with neutrophil predominance, and renal dysfunction was noted. He did not respond to treatment with antibiotics, and the worsened renal function soon required hemodialysis. On the seventh hospital day, he suddenly developed massive melena. A colonoscopic examination suggested bleeding in the small intestine, and abdominal angiography demonstrated that the bleeding originated in a branch of the ileal artery. Hemostasis was achieved by transarterial embolization (TAE), but the patient suffered a massive pulmonary hemorrhage 2 days after the TAE. Although he responded well to a combination treatment with corticosteroid and cyclophosphamide, recurrence of pulmonary hemorrhage led to death, on the 87th hospital day. MPA in this patient was associated with three serious complications; deteriorating renal function, massive melena, and pulmonary hemorrhage. Of the various manifestations associated with MPA, arterial bleeding in the gastrointestinal tract, although rare, should be considered as one of the serious complications in MPA.

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Section: Discussionmentioning

confidence: 89%

Microscopic polyangiitis complicated with massive intestinal bleeding

Ueda¹,

Matsumoto²,

Ahn³

et al. 2001

Journal of Gastroenterology

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“…Isolated ischemic proctosigmoiditis accounts for only approximately 5% of all cases of ischemic colitis, and it has been reported to occur following abdominal aortic surgery or implantation of aortic stents, secondary to vasculitis, due to myointimal hyperplasia of mesenteric veins and following radiotherapy [1,9,11,12,13,14]. Nevertheless, isolated ischemic proctosigmoiditis is most commonly related to non-occlusive conditions and this is supported by our findings, where six of seven patients had at least one reason for a low flow state and subsequent non-occlusive rectosigmoidal ischemia.…”

Section: Discussionmentioning

confidence: 99%

CT findings in isolated ischemic proctosigmoiditis

et al. 2002

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The purpose of our study was to describe the CT features of ischemic proctosigmoiditis in correlation with clinical, laboratory, endoscopic, and histopathologic findings. Our study included seven patients with isolated ischemic proctosigmoiditis. Patients were identified by a retrospective review of all histopathologic records of colonoscopic biopsies performed during a time period of 4 years. All patients presented with left lower abdominal quadrant pain, bloody stools, and leukocytosis, and four patients had fever at the time of presentation. Four of seven patients suffered from diarrhea, one of seven was constipated and two of seven had normal stool consistency. The CT examinations were reviewed by two authors by consensus and compared with clinical and histopathologic results as well as with the initial CT diagnosis. The CT showed a wall thickening confined to the rectum and sigmoid colon in seven of seven patients, stranding of the pararectal fat in four of seven, and stranding of the perisigmoidal fat in one of seven patients. There were no enlarged lymph nodes, but five of seven patients showed coexistent diverticulosis and in three of these patients CT findings were initially misinterpreted as sigmoid diverticulitis. Endoscopies and histopathologic analyses of endoscopic biopsies confirmed non-transmural ischemic proctosigmoiditis in all patients. Isolated ischemic proctosigmoiditis often presents with unspecific CT features and potentially misleading clinical and laboratory findings. In an elderly patient or a patient with known cardiovascular risk factors the diagnosis of ischemic proctosigmoiditis should be considered when wall thickening confined to the rectum and sigmoid colon is seen that is associated with perirectal fat stranding.

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“…[17] Sigmoid perforation and mesocolic hematoma has also been reported in a patient with polyarteritis nodosa. [18] Most of the cases of spontaneous bleeding in association with PAN were established antemortem but in few cases diagnosis could be established only post autopsy. [17] Perirenal hemorrhage can be unilateral and bilateral with or without involvement of other organs.…”

Section: Discussionmentioning

confidence: 99%