Polyarthritis Nodosa Requiring a Subtotal Resection of the Small Intestine for Multiple Intestinal Perforations

Abstract

A 38-year-old woman, who had had fever and abdominal pain, was admitted. Upper gastrointestinal endoscopy showed two longitudinal ulcers in the lower esophagus. Lower gastrointestinal endoscopy revealed many deep irregular longitudinal ulcers in the terminal ileum. Twenty-one days later, she had severe abdominal fullness and pain. CT showed free air and ascites, and emergency laparotomy was performed. Because many perforations were observed in the small intestine, subtotal resection of the small intestine was performed. Macroscopic findings of the resected specimen showed many fissure-shaped ulcers. Histopathological examination showed bleeding, necrosis, infiltration of inflammatory cells including neutrophils, and fibrinoid necrosis of the arterial wall, indicating polyarteritis nodosa (PN). She has had a normal social life with home parenteral nutrition since hospital discharge. Although PN rarely presents with gastrointestinal symptoms, the small intestine is the most common organ involved. It should be noted that patients with small bowel PN frequently have acute abdomen due to intestinal necrosis or perforation.