A CASE OF POLYARTERITIS NODOSA CAUSING SMALL INTESTINAL NECROSIS WHICH PRESENTED ACUTE ABDOMEN

Abstract

A 29-year-old man was urgently admitted to the hospital because of abdominal pain and vomiting. He developed waterly diarrhea on the second day after admission. Moreover, an abdominal computed tomography showed massive ascites, intestinal edema and paralytic ileus on the sixth day.Emergency laparotomy was performed with a diagnosis of acute peritonitis. At operation, 1800ml of serous ascites and severe inflammation of the small intestine were noted. Ninety centimeter of the necrotic small intestine was resected, followed by establishment of jejunostomy and ileostomy. Histological examination of the resected material revealed fibrinoid necrosis with neutrophil infiltration at submucosal small artery and the diagnosis of polyarteritis nodosa was made. The patient suffered from renal failure after the operation, but he recovered with hemodialysis. Steroid therapy was conducted as a treatment of primary disease. Polyarteritis nodosa with necrosis of the small intestine is relatively rare. All the cases reported in Japan are accumulated and some bibliographical notes are also presented.