Vasculitides of the gastrointestinal tract

Müller‐Ladner, Ulf

doi:10.1053/bega.2000.0156

Cited by 43 publications

(33 citation statements)

References 110 publications

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“…Intestines, especially small intestines, are the most commonly involved organs. 6 SOV is often found incidentally in the course of biopsies or surgery for suspected malignancy, infection, or structural abnormalities. There have been case reports of acute abdomen and mega-colon resulting from SOV of the intestines.…”

Section: Discussionmentioning

confidence: 99%

Rare Case of Vasculitis of the Hepatic Artery

Mali

Muduganti

Goldberg

2015

Clinical Medicine & Research

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Vasculitis is an accumulation of inflammatory leucocytes in the blood vessels with reactive damage to mural structures. Isolated vasculitis of the gastrointestinal tract without systemic involvement is rare. We report a unique case of a female patient who presented with abdominal pain, and was found, on serology, to have elevated inflammatory markers without autoantibodies. A computed tomography scan of the abdomen and pelvis was suggestive of vasculitis of the hepatic artery. To the best of our knowledge, this is the first case, to date, of vasculitis of hepatic artery. Vascul itis is an accumulation of inflammatory leucocytesin the blood vessels with reactive damage to mural structures. Vasculitis of the gastrointestinal tract is a manifestation of systemic vasculitis in 20% of cases, 1 but isolated vasculitis of the gastrointestinal tract without systemic involvement is rare. We report a unique case of a female patient who presented with abdominal pain, and was found, on serology, to have elevated inflammatory markers without autoantibodies. A computed tomography scan of the abdomen and pelvis was suggestive of vasculitis of the hepatic artery. To the best of our knowledge, this is the first reported case of vasculitis of the hepatic artery. There have been reports of single organ vasculitis, especially in the intestines, gallbladder, and appendix; however, to date, none have been reported in the liver. Case PresentationA 53-year-old woman with a past history of cholecystectomy was admitted with complaint of epigastric discomfort of 2-days duration. The pain was localized, and she reported bloating and nausea, but denied vomiting, fever, chills, melena, urinary or gastrointestinal complaints.Physical examination showed the patient was afebrile with stable vital signs. Her cardiovascular and respiratory examinations were normal. Abdominal examination demonstrated minimal tenderness on deep palpation of the epigastrium without distension, guarding, or rigidity. A complete blood count showed normal white blood cell count at 6.3 x 10 3 /μL and normal hemoglobin at 14.2 g/dL. Basic metabolic panel and liver enzymes were normal, and amylase and lipase levels were not elevated.Radiographs of the abdomen revealed normal bowel gas pattern, but a CT scan of the abdomen and pelvis showed circumferential thickening of the wall of the common hepatic artery and its right and left hepatic branches, with a narrowed but patent lumen, suggestive of vasculitis (figure 1). The remaining arteries of the abdomen and pelvis were unremarkable. A CT scan of the abdomen and pelvis taken 2 years prior had been unremarkable. Magnetic resonance angiography (MRA) of the visceral arteries of the abdomen and pelvis confirmed the findings.The erythrocyte sedimentation rate (ESR) upon admission was elevated at 25 mm/hr (normal 0-17 mm/hr) and C-reactive protein (CRP) was elevated at 2.6 mg/dL (normal 0-1 mg/dL). Further history and examination was done to rule out systemic vasculitis in view of the elevated sedimentation rate. The patient de...

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Section: Discussionmentioning

confidence: 99%

Rare Case of Vasculitis of the Hepatic Artery

Mali

Muduganti

Goldberg

2015

Clinical Medicine & Research

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“…Approximately two-thirds of the patientshave abdominal pain, nausea, vomiting, or other manifestations associated with GI ischemia and infarction [3,[5][6][7] . The clinical course is often dramatic.…”

Section: Medium-sized-vessel Vasculitismentioning

confidence: 99%

“…Of note, bowel ischemia and perforations are significantly associated with increased mortality [4] . Knowledge of endoscopic and radiographic GI manifestations can suggest the possibility of systemic vasculitis and help establish the specific diagnosis [5][6][7] . Although radiographic features of vasculitis involving the GI tract have been well studied especially in computed tomography (CT), the combination of endoscopic and radiographic features has not been fully evaluated.…”

Section: Primary Vasculitismentioning

confidence: 99%

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Endoscopic and radiographic features of gastrointestinal involvement in vasculitis

Hokama

Kishimoto²,

Ihama³

et al. 2012

WJGE

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Vasculitis is an inflammation of vessel walls, followed by alteration of the blood flow and damage to the dependent organ. Vasculitis can cause local or diffuse pathologic changes in the gastrointestinal (GI) tract. The variety of GI lesions includes ulcer, submucosal edema, hemorrhage, paralytic ileus, mesenteric ischemia, bowel obstruction, and life-threatening perforation.The endoscopic and radiographic features of GI involvement in vasculitisare reviewed with the emphasis on small-vessel vasculitis by presenting our typical cases, including Churg-Strauss syndrome, HenochSchönlein purpura, systemic lupus erythematosus, and Behçet's disease. Important endoscopic features are ischemic enterocolitis and ulcer. Characteristic computed tomographic findings include bowel wall thickening with the target sign and engorgement of mesenteric vessels with comb sign. Knowledge of endoscopic and radiographic GI manifestations can help make an early diagnosis and establish treatment strategy.

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“…Digestive manifestations of vasculitides and systemic diseases include a number of clinical conditions (Table 3) [32] . The development of GI symptoms raises three main questions: Do the digestive symptoms correspond to the initial manifestation of the condition or to a new acute phase of the disease?…”

Section: Introductionmentioning

confidence: 99%

Capsule endoscopy in non-steroidal anti-inflammatory drugs-enteropathy and miscellaneous, rare intestinal diseases

Gay¹,

Delvaux²,

Frederic³

2008

WJG

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Despite significant advances over the last decade, mucosal lesions of the small bowel are poorly detected by imaging studies such as CT scan, MRI-enteroclysis and contrast-enhanced abdominal ultrasound. Capsule endoscopy (CE) has dramatically changed the diagnostic approach to intestinal diseases. Moreover, the use of CE can be extended to include other conditions. However, it is difficult to assess the positive influence of CE on patient outcomes in conditions involving a small number of patients, or in critically ill and difficult to examine patients. CE has the advantage of diagnosing intestinal lesions and of directing the use of double balloon enteroscopy (DBE) in order to obtain biopsy specimens. Moreover, CE allows repeated assessment in chronic conditions, especially to detect relapse of an infectious disease.

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Vasculitides of the gastrointestinal tract

Cited by 43 publications

References 110 publications

Rare Case of Vasculitis of the Hepatic Artery

Rare Case of Vasculitis of the Hepatic Artery

Endoscopic and radiographic features of gastrointestinal involvement in vasculitis

Capsule endoscopy in non-steroidal anti-inflammatory drugs-enteropathy and miscellaneous, rare intestinal diseases

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