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Emergency Surgery for Gastrointestinal Complications in Patients With Granulomatosis With Polyangiitis and
Masatoshi Inoue1, Ryosuke Ichihara2, Miya Hiramatsu1
1Nephrology, Asahi University Hospital, Gifu, JPN.
Abstract:
Gastrointestinal (GI) involvement in granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) is rare but potentially life-threatening. We report two cases of GPA/MPA complicated by GI bleeding and perforation, both requiring emergency surgical intervention. The first case involved a man in his 30s with GPA who developed massive small bowel bleeding following treatment with high-dose corticosteroids and rituximab. The second case involved an elderly man with MPA, complicated by Clostridioides difficile enteritis and subsequent colonic perforation. These cases suggest that not only primary vasculitic vascular injury but also secondary factors, such as immunosuppressive therapy and opportunistic infections like Clostridioides difficile, may synergistically contribute to the development of severe GI complications. Surgical strategies must be carefully tailored based on disease activity, overall clinical condition, and corticosteroid exposure, with an emphasis on balancing the risks of rebleeding, infection, and healing failure in the context of systemic vasculitis. Emerging therapies such as avacopan may help mitigate the risk of GI complications. Early recognition and multidisciplinary management are essential to improving outcomes in patients with GI involvement in GPA/MPA.
Insights
Gastrointestinal complications in granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) can be severe. Factors like immunosuppression and infection contribute, necessitating tailored surgical and multidisciplinary approaches.
Area of Science:
- Rheumatology
- Gastroenterology
- Surgical Pathology
Background:
- Gastrointestinal (GI) involvement in granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) is uncommon but carries significant morbidity and mortality.
- Prompt diagnosis and management are crucial for patients presenting with severe GI manifestations.
Observation:
- Two cases of GPA/MPA with severe GI complications are presented: massive small bowel bleeding in a GPA patient on corticosteroids and rituximab, and colonic perforation with Clostridioides difficile enteritis in an MPA patient.
- Both cases required emergency surgical intervention, highlighting the critical nature of these GI events.
Findings:
- Severe GI complications in GPA/MPA result from a combination of primary vasculitic injury and secondary factors, including immunosuppressive therapy and opportunistic infections (e.g., Clostridioides difficile).
- Surgical management must be individualized, considering disease activity, patient condition, and prior corticosteroid use to mitigate risks like rebleeding, infection, and impaired healing.
Implications:
- Emerging therapies like avacopan may reduce the incidence of GI complications in GPA/MPA.
- Multidisciplinary care and early recognition are paramount for improving outcomes in patients with GI involvement in systemic vasculitis.
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