2020 Volume 53 Issue 1 Pages 22-29
A 45-year-old man who presented with fever, polyarthritis and deafness was referred to our hospital, and given a diagnosis of granulomatosis with polyangiitis. Twelve days after starting corticosteroid and cyclophosphamide therapy, he suddenly developed abdominal pain. Abdominal CT scan showed an edematous small intestine with free air and fluid collection in the pelvis. Emergency laparotomy was performed for diagnosis of gastrointestinal perforation, which revealed 5–10 mm erythematous lesions at 20 sites on the anti-mesenteric side of the small intestine. Three of these lesions were perforated. Local resection with anastomosis were performed at each site. The postoperative course was uneventful, and medical treatment was resumed 9 days after the operation. Fifty-three days postoperatively, he developed abdominal pain again. Abdominal CT scan showed a partially-dilated small intestine with a small amount of ascites, suggesting a strangulated obstruction. Emergency laparotomy was performed, which showed edema at one of the previous anastomotic sites with a small amount of purulent ascites. There was no evidence of strangulation or perforation of the intestine. An omental patch was placed over the anastomotic site, and a drain placed in the pelvis. The postoperative course was uneventful, and he restarted medical treatment. Histopathology of the resected specimen showed vasculitis at the sites of perforation, suggesting a relationship with granulomatosis with polyangiitis. We report a patient with granulomatosis with polyangiitis with multiple perforations of the small intestine. Special attention should be paid for re-perforation in the treatment of the disease. Furthermore, medical information should be shared with patients and their families as well as medical staff.
