Multiple small intestinal perforations in a patient with Hepatitis B Virus-associated Polyarteritis Nodosa

We present the case of a 38-year-old patient with a history of Hepatitis B Virus-associated Polyarteritis Nodosa, who presented with acute abdomen and septic shock. The patient initially had three perforations of the small intestine that were treated with segmental enterectomy and anastomosis at two sites. During his postoperative course he continued to develop new perforations and necrotic lesions along the whole length of the small intestine, that mandated repetitive laparotomies and the technique of the open abdomen was employed. Despite the aggressive surgical treatment and the medical treatment with corticosteroids, cyclophosphamide and plasma exchanges, the patient died 15 days after the first operation due to septic shock and multiple organ failure.