Three Case Reports of Necrosis and Perforation of Intestine Due to Connective Tissue Disease

Hideki Idei, Tomoaki Urakawa, Mitsuharu Nakamoto, Toshimasa Yamaguchi, Yasutomo Azumi, Hiroaki Tanaka, Atsunori Iso, Yukio Nishio, Teruo Ioroi, Kiyoshi Uematsu, Kohichi Setoh, Tomohiko Kizaki*

Department of Surgery, Kobe Rosai Hospital of the Labour Welfare Corporation
*Second Department of Pathology, School of Medicine, Kobe University

We encountered three cases of necrosis and perforation of the intestinal wall due to abdominal angitis complicated with connective tissue disease. Case 1 was a 52-year-old male, case 2 was a 69-year-old female, and case 3 was a 46-year-old female. The underlying diseases were, respectively, periateritis nodosa, rheumatoid arthritis, and systemic lupus erythematosus. All cases had severe abdominal pain and the site of necrosis and perforation was ileum. The surgery performed was resection of the lesion and direct anastomosis. Colostomy of the transverse colon was also performed in case 1. In the small arteries of the resected intestinal segments, hypertrophy of the tunica intima, stenosis of the lumen and fresh thrombus were observed. Complete occulusion and recanalization were also noted in some areas. After surgery, cases 1 and 2 died within 12 days and 2 days, respectively in one case due to recurrence of the necrosis and perforation and in the other due to multiple organ failure. Case 3 has survived 7 months at the present. Necrosis and perforation of the digestive tract due to abdominal angitis complicatd with connective tissue disease apperas as one of the symptoms of systemic angitis. Therefore, determination of the range of resection of the gastrointestinal tract is important at operation. In addition, careful systemic therapy after operation by the use of intravenous hyperalimentation, steroids, and antibiotics is important.

Key words
connective tissue disease, necrosis or perforation of intestine, abdominal angitis with connective tissue disease

Reprint requests
HidekiIdei Department of Surgery, Kobe Rosai Hospital of the Labour Welfare Corporation
2-140 Tomogaoka, Suma- ku, Kobe, 654 JAPAN

Accepted
November 8, 1989

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