A Case of Classic Polyarteritis Nodosa Presenting as Acute Abdomen -A Review of 50 Patients with PN Involving Small Intestine Undergone Laparotomy in Japanese Litetature-

Tomoaki Takada¹⁾²⁾, Hideaki Yoshida¹⁾, Morio Tsukada¹⁾ and Hiroyuki Katoh²⁾

¹⁾Department of Surgery, Yoichi Kyokai Hospital
²⁾Surgical Oncology, Division of Cancer Medicine, Hokkaido University Graduate School of Medicine

A 79-year-old man diagnosed with a small bowel obstruction was referred for abdominal pain and vomiting. Following up hypertension and brain infarction, he had a history of laparotomy for a rupture of the jejunal mesentric artery and was found on physical examination to have a distended, tympanic abdomen with tenderness of the umbilicus but without rebound tenderness or muscular guarding. No palpable masses were found. Abdominal radiography, ultrasonography (US) and computed tomography (CT) showed a small bowel obstruction. Strangulated ileus was diagnosed preoperatively. Emergency laparotomy showed an ileum 30 cm from the ligament of Treitz 2 m with ischemic change. Pathologically, we diagnosed necrotizing arteritis with fibrinoid necrosis in the mesentery suggestive of polyarteritis nodosa (PN) complicated by ischemic enteritis. Our case fulfills the diagnostic criteria for PN established by the Ministry of Health and Welfare of Japan in 1998. The patient had a smooth postoperative course. PN presenting as acute abdomen is rare. We review 50 patients with PN involving small intestine undergone laparotomy in the Japanese literature.

Key words
polyarteritis nodosa, acute abdomen, ischemic enteritis

Reprint requests
Tomoaki Takada Department of Surgery, Yoichi Kyokai Hospital 85 Kurokawa-cho, Yoichi-cho, Yoichi-gun Hokkaido, 046-0003 JAPAN

Accepted
September 25, 2002

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