Upper gastrointestinal endoscopy in systemic vasculitis presenting as an acute abdomen

Area of Science:

• Gastroenterology
• Rheumatology
• Pathology

Background:

• Systemic vasculitis can manifest with gastrointestinal (GI) symptoms, but the GI tract is rarely the primary target organ.
• Diagnosing upper GI vasculitis can be challenging, as radiological imaging is often unrevealing during acute presentations.

Observation:

• This study details three cases of upper GI vasculitis presenting as acute abdominal emergencies.
• Endoscopy proved vital in identifying early and advanced bleeding lesions in polyarteritis nodosa (PAN) and Henoch-Schoenlein disease.
• Histological confirmation supported endoscopic findings of gastric and duodenal vasculitic lesions.

Findings:

• Endoscopic assessment facilitated the documentation of vasculitic lesions in the stomach and duodenum.
• Early and aggressive medical management, guided by endoscopic findings, led to successful outcomes in these cases.
• Gastroduodenoscopy is underutilized in the emergency assessment of vasculitis patients with acute abdominal pain.

Implications:

• Upper GI vasculitis, though uncommon, is a serious complication when the GI tract is the primary site of disease.
• Endoscopic evaluation can significantly alter the diagnostic and therapeutic approach, potentially improving outcomes.
• Increased awareness and utilization of gastroduodenoscopy are recommended for patients with suspected GI vasculitis.