Polyarteritis nodosa with perforation of the cecum

Abstract

the appendix (2,6). Appendicitis, appendiceal perforation and appendiceal abscess can occur days to years after FB ingestion (6). The metal pin was ingested unintentionally three years before presentation to our hospital. FBs in the appendiceal lumen may cause inflammation, perforation and peritonitis, and appendicitis can occur days to years after FB ingestion. Surgery seems to be the only effective therapeutic approach to treat FBs in the appendix. 188 REFERENCES Polyarteritis nodosa with perforation of the cecum Poliarteritis nodosaya ba¤l› çekum perforasyonuTo the Editor, Polyarteritis nodosa (PAN) is a systemic vasculitis involving small-and medium-sized arteries, and it may present with various clinical features. We report herein a case of PAN presented with perforation of the cecum, which is seen very rarely.A 12-year-old boy was referred to our hospital with a possible diagnosis of appendicitis. He had been operated for ventricular septal defect during infancy, and recurrent aphthous ulceration was noted in his medical history. In his physical examination, diffuse abdominal tenderness was noted; there was no significant abnormality in the rest of the physical examination. Laboratory investigations revealed pathologic leukocytosis (WBC: 24,500/mm 3 ) and highly elevated C-reactive protein (CRP) (162 mg/dl). Abdominal ultrasonography showed a marked edematous appendix and minimal pericholecystic fluid. During the operation, the appendix was seen as hyperemic. On the antimesenteric surface of the cecum and distal colon, ulcerated and ischemic lesions were seen, 3-4 mm in diameter. During exploration following the appendectomy, the perforated portion of the intestine (2-3 cm in length) was opened. When the intestinal mucosa from the perforated site was inspected, lesions 2-10 mm in length were seen on the internal surface of the cecum and colon over a 10 cm segment. The cecocolic segment including these lesions was resected, and side-to-side anastomosis was performed. The histopathological evaluation revealed mucosal erosions, particularly in the walls of the small-and medium-sized vessels, which were in the granulation tissue with inflam-

Primary cecal pathologies presenting as acute abdomen and critical appraisal of their current management strategies in emergency settings with review of literature

“…These potentially incriminating pathologies that can present as acute cecal pathology have been tabulated in Table 2 . [ 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 ] But only some of these conditions are commonly encountered in the clinical practice, and they deserve special attention owing to their dismal outcome. It may be noted that in most of the above-mentioned causes of acute primary cecal pathology, patients were initially suspected to be having acute appendicitis or appendicular perforation and the cecal pathology was appreciated only intra-operatively or on post-operative HPE reporting.…”