Colonic Perforation in Polyarteritis Nodosa With Concurrent Perforated Sigmoid Diverticulitis

Area of Science:

• Vascular Medicine
• Gastroenterology
• Surgical Pathology

Background:

• Polyarteritis nodosa (PAN) is a systemic medium-sized vasculitis.
• Gastrointestinal involvement in PAN, though rare, can lead to severe complications.
• Acute surgical abdomen is an uncommon but critical manifestation of PAN.

Observation:

• A patient with newly diagnosed PAN presented with large bowel perforation.
• The clinical presentation was complicated by a concurrent, separate sigmoid diverticulitis perforation.
• This dual pathology created a diagnostic challenge, mimicking a singular cause for the acute abdomen.

Findings:

• The case demonstrates a rare instance of gastrointestinal perforation directly attributed to Polyarteritis nodosa.
• Concurrent sigmoid diverticulitis presented a diagnostic dilemma, potentially masking or exacerbating the PAN-related bowel injury.
• Successful management required high clinical suspicion for PAN and prompt surgical intervention.

Implications:

• Early recognition of PAN-induced gastrointestinal complications is crucial for timely intervention.
• Diagnostic strategies for acute surgical abdomen in patients with vasculitis must consider multiple potential etiologies.
• This case underscores the importance of a comprehensive diagnostic approach in complex surgical presentations.