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Successful management of multiple small bowel perforations due to polyarteritis nodosa
Seyed Hamzeh Mousavie1, Rezvan Mirzaei2, Bahar Mahjoubi2
1Department of General Surgery, Division of Colon and Rectal Surgery, Hazrat-e-Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran.
Abstract:
Classic Polyarteritis nodosa (PAN)) is a medium-sized vessel vasculitis that usually occurs in middle-aged men. One of the dramatic manifestations of PAN that requires surgical intervention is multiple small bowel perforations. Many studies have reported a high rate of mortality in PAN due to acute abdominal complications. We report here the case of multiple small bowel perforations in a 22-year-old man, who presented with an acute abdomen, and eventually, PAN was diagnosed. In our case, PAN led to multiple small bowel perforations and diffuse patchy necrosis. All perforations were primarily repaired and corticosteroids were prescribed. Using corticosteroid in patients with abdominal sepsis is injurious; however, laparostomy is the method we suggest, to achieve the purpose, including prevention of a short bowel and infection control. Our patient was discharged, well, after 48 days of hospitalization and referred to a rheumatologist.
Insights
Polyarteritis nodosa (PAN) can cause life-threatening small bowel perforations. This case highlights surgical repair and corticosteroid management in a young adult with PAN, emphasizing laparostomy for infection control and preventing short bowel syndrome.
Area of Science:
- Vascular Medicine
- Gastroenterology
- Rheumatology
Background:
- Polyarteritis nodosa (PAN) is a medium-vessel vasculitis typically affecting middle-aged men.
- Acute abdominal complications, such as small bowel perforations, are severe manifestations of PAN with high mortality rates.
Observation:
- A 22-year-old male presented with acute abdomen secondary to multiple small bowel perforations and diffuse patchy necrosis.
- Diagnosis of PAN was established following the presentation of acute abdominal complications.
Findings:
- Surgical repair of all bowel perforations was performed.
- Corticosteroids were administered, despite the risks associated with their use in abdominal sepsis.
- Laparostomy was employed as a strategy for infection control and prevention of short bowel syndrome.
Implications:
- This case underscores the importance of considering PAN in young adults presenting with acute abdomen and bowel complications.
- The management strategy highlights the potential utility of laparostomy in complex cases of PAN with abdominal sepsis.
- Early diagnosis and appropriate management are crucial for improving outcomes in patients with PAN-related gastrointestinal emergencies.
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