Vasculitis associated with intestinal bypass surgery

Abstract

We report two cases in which necrotizing vasculitis with tenosynovitis arthralgia/arthritis syndrome developed after intestinal bypass surgery. Each of these patients had jejunoileostomies, and the excluded segment was placed in an ileal-colonic anastomosis. We speculate that since the attachment of the excluded segment to the large intestine predisposes it to increased bowel overgrowth of bacteria, these bacteria or their debris may have served as antigens for circulating immune complexes, which were detected in both patients by one or more techniques. Patients who have had an end-to-side anastomosis may be less predisposed to the more severe vasculitis syndrome because there is less likelihood of bacterial overgrowth in the bypassed intestinal segment.

Chronic granulomatous disease and acute neutrophilic dermatosis

“…The patient's colitis-related fistulae associated with vasculitis and marked pustulation raises the possibility of bowel-associated pustular vasculitis. 8,9 This condition, characterized by a pustular, vasculitic rash and arthritis, is thought to be an immune complex-mediated reaction secondary to bacterial overgrowth within stagnant, blind-loops of bowel. However the conspicuous lack of response to broad spectrum antibiotics and absence of arthritis in our patient makes this diagnosis less likely.…”

Spondyloarthropathy After Ampullary Carcinoma Resection

“…4,8,10 With rare exception, reanastomosis to reestablish bowel continuity has eliminated the syndrome. 9,10, [15][16][17] Although originally described after jejuno-iliac bypass, BADAS occurs more commonly after a jejuno-colic anastomosis 18 and has also been described in association with bilio-pancreatic diversion or bilio-intestinal bypass for morbid obesity, 19,20 Crohn disease, ileoanal pouch anastomosis, 21,22 ulcerative colitis, appendicitis, 23 diverticulitis, 11 and after Billroth II gastrectomy. 16,24 The standard surgical approach to carcinoma of the ampulla of Vater is the Whipple procedure, which involves en bloc resection of the gastric antrum and duodenum, a segment of the first portion of the jejunum, gallbladder, and distal common bile duct, the head and often the neck of the pancreas, and adjacent regional lymph nodes.…”