Abstract
We report a case of billary peritonitis due to gangrenous cholecystitis caused by polyarteritis nodosa. A 36-year-old female was diagnosed to have polyarteritis nodosa and was receiving steroid pulse therapy. During her hospital stay, she developed severe right hypochondralgia and was diagnosed as having noncalculous cholecystitis. Cholecystectomy was performed, based on the diagnosis of billary peritonitis with gangrenous cholecystitis. Pathological examination revealed vasculitis in the perforated gallbladder wall. Postoperatively, several severe complications occurred, such as bile leakage and an intractable fistula, and the symptoms of polyarteritis nodosa also worsened. Surgical operations may cause severe damage of organs if they are performed during the active phase of PN. Therefore, when patients with polyarteritis nodosa present with acute cholecystitis, caution must be exercised during the operation, with surgery conducted only in cases with absolute operative indications. Priority should clearly be given to the treatment of systemic PN with corticosteroids and cyclophosphamide.
