A Case of Small Intestinal Necrosis Caused by Polyarteritis Nodosa

Abstract

A 63-year-old man presented with severe abdominal pain. He had fever, muscle pain in the neck and lower leg for two weeks prior to visiting the hospital. He was diagnosed as having pyelonephritis, and was hospitalized for six days. He was readmitted because of strong abdominal pain two days after hospital discharge and was referred to our department with the suspicion of intestinal ischemia. On physical examination, he was found to have a distended abdomen with rebound tenderness. Computed tomography showed ascites, dilation of the small intestine, and poorly-enhanced intestinal walls in a part of the small intestine. Emergency laparotomy was performed because acute mesenteric ischemia was suspected. The small intestine was generally dilated, and the color of some areas was poor. There were two areas of transmural necrosis in the small intestine, and we resected these.
Pathologically, the arteries had inflammatory cell infiltration that mainly comprised neutrophils. Many areas of angitis had fibrinoid necrosis in the small intestine. We diagnosed polyarteritis nodosa, based on the criteria of the Ministry of Health, Labour and Welfare of Japan. Steroid therapy was administered, and the patient was discharged 80 days after surgery.