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A Case Report of Periarteritis Nodosa, Showing Various Intestinal Lesions such as Infarction, Bleeding, Ulcer and Perforation I. Sekine 1 , H. Itakura 1 , S. Taura 2 , Y. Sho 3 1Dept. of Pathology, Institute for Tropical Med., Nagasaki Univ 22nd Dept. of Surgery, Nagasaki Univ., School of Med 31st Dept. of Surgery, Ryuku Univ., Faculty of Hygiene pp.1525-1530
Published Date 1975/11/25
DOI https://doi.org/10.11477/mf.1403112194
  • Abstract
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 A case of polyarteritis, especially involving the bowel, is reported. A 70-year-old male was admitted to the hospital in November 1972 complaining of severe lower abdominal pain, distension of abdomen, constipation, nausea and vomiting. The first surgical exploration of the abdomen was performed shortly after admission. Two patchy areas of necrosis involving the ileum were found and partial ileal resection with anastomosis was performed. Study of ileum resected at that time confirmed only acute infarctions of the bowel wall. There was remarkable improvement until March 1973, when he was again admitted to the hospital with pain and distension in the right lower abdomen. On the second admission, there were hypoplastic anemia, hypoproteinemia, hypergammaglobulinemia and hypocholesteremia. A superior mesenteric arteriogram showed stenosis, meandering and development of collateral circulation of small branches of ileocolic artery. At the second operation, multiple ulcers and thickening of mesentery were found. Partial ileocaecal resection with anastomosis was performed. Multiple ulcers were based on the antimesenteric border, irregular in shape and surrounded by highly regenerated villi. Microscopically, the small arteries and arterioles of the mesentery and the bowel wall presented necrotizing arteritis with acute and chronic inflammatory changes, fibrinoid degeneration and intimal fibrosis, presenting stenosis and occlusion, in which lesions were of varying stages. The areas of thickening of the bowel wall were caused by mucosal and submucosal fibrosis. Postoperatively, the patient's condition remained poor. Melena and pneumonia developed, and in spite of treatment with steroids and antibiotics, he expired 2 months after the second operation.

 At autopsy, there were perforations of large intestine with focal suppurative peritonitis. Although widespread arteritis involved many organs, the lesion was not severe. The lungs revealed extensive interstitial pneumonia.

 Gastrointestinal involvement in polyarteritis has been frequently reported in Western countries but very rarely in Japan.


Copyright © 1975, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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