Successful management of catastrophic gastrointestinal involvement in polyarteritis nodosa

A patient with polyarteritis nodosa developed necrotizing enterocolitis, as indicated by pneumatosis intestinalis seen on computed tomographic scans of the abdomen. Despite immunosuppressive therapy and concomitant resolution of the intramural and portal venous gas and general clinical improvement, on 2 occasions (between 20 and 30 days later) the patient developed bowel infarctions and perforations that necessitated bowel resection. Leaks developed at anastomotic sites, but were not closed surgically. However, these sites and the lower quadrants of the abdomen were drained, and the patient was given total parenteral nutrition. Over a 2-month period the patient completely recovered from this nearly always fatal gastrointestinal complication of polyarteritis nodosa. The medical, surgical, and radiographic approach we used may be applicable to the management of similar cases in the future.