2019 Volume 61 Issue 12 Pages 2617-2623
A 78-year-old man was admitted to our hospital complaining of abdominal pain. He had purpura, and endoscopy revealed mucosal edema and erosions in the duodenum, suggesting IgA vasculitis (IAV). Deep duodenal biopsy specimens containing submucosal vessels enabled us to make a pathological diagnosis of IAV with necrotizing vasculitis. On the sixth hospital day, he developed abdominal bloating and lack of bowel sounds. Computed tomography (CT) showed dilatation of the small intestine. We diagnosed functional ileus since there was no evidence of organic lesions causing intestinal obstruction on CT, including perforation or intussusception. An ileus tube was inserted for decompression of the small intestine.
In addition, intravenous prednisolone (50 mg/day) was administered. On the third day of this treatment, his abdominal symptoms were improved with resolution of ileus, allowing us to remove the ileus tube on the following day. In conclusion, endoscopic findings are helpful for suggesting the possibility of IAV, while deep mucosal biopsy is key for pathological diagnosis.
