[Intestinal vasculitis--a diagnostic-therapeutic challenge]

Intestinal vasculitis is a rare cause of mesenteric ischemia. It results in chronic arterial insufficiency in most cases, sometimes in acute mesenteric ischemia. Abdominal symptoms like postprandial intestinal angina, diarrhea, anorexia, and perforation are nonspecific and do not allow for differentiation between vasculitic and noninflammatory causes of mesenteric ischemia. Conventional radiography and endoscopy can not prove the underlying process either. Therefore, extraintestinal symptoms of vasculitis must be observed carefully for diagnosing a systemic vasculitis with potential involvement of intestinal arteries. Extraintestinal manifestations are multifacetted including malaise, rheumatic symptoms and more specific findings like cutaneous efflorescences and organ-specific vasculitic damages due to ischemia of inner organs, nerves and sensory organs. While some vasculitic disorders are characterized by specific laboratory markers (ANCA, anti-ds-DNA antibodies), others appear with less specific signs. Prior to treatment, the diagnosis should be established by biopsy of suspect tissue and subsequent histologic analysis. Angiography can be helpful in diagnosis of syndromes involving medium-sized or larger vessels. The treatment of choice is glucocorticoids, while in patients with extensive visceral, especially renal involvement, cyclophosphamide should be added. When glucocorticoids can not be tapered or the disease can not be controlled other immunosuppressive agents should be employed. In difficult diagnostics with mere suspicion of vasculitis glucocorticoids may be given ex juvantibus and fairly often prove effective.