A CASE OF POLYARTERITIS NODOSA CAUSING UNCONTROLLED GASTROINTESTINAL BLEEDING

Abstract

A 65-year-old man complaining of nausea and abdominal fullness was admitted to our hospital. An upper gastrointestinal endoscopic study revealed consecutive erosion, ulcer and bleeding in the second portion of the duodenum. Abdominal CT scan showed widespread inflammation of small intestine. Endoscopic biopsy from duodenal mucosa did not reveal a definite diagnosis. After admission, the patient passed massive blood in his stool repeatedly. Because angiography revealed bleeding from a branch of iliocolic artery, TAE was performed. But massive melena recurred, so partial resection of the ileum was performed. The pathological diagnosis was polyarteritis nodosa. Although steroid pulse therapy and CHDF for renal failure were begun, melena recurred and the patient died. In a case of uncontrolled hemorrhagic enteritis, arteritis including PN must be taken into account for rapid diagnosis and proper therapy.