A Case of Allergic Granulomatous Angitis Causing Small Intestinal Perforation

Koji Maeda, Shuzo Kono, Kazuo Kitagawa, Tomoyoshi Okamoto, Katsuhiko Yanaga¹⁾ and Takao Ohki²⁾

Department of Surgery, Jikei University Daisan Hospital
Department of Surgery¹⁾ and Department of Vascular Surgery²⁾, Jikei University School of Medicine

A 74-year-old man suffereing from bronchial asthma for six years reporting diarrhea, constipation, and abdominal pain underwent steroid pulse treatment with methylprednisolone at 1,000 mg/day administered for three days, followed by internal use of prednisolone at 50 mg/day based on a diagnosis of allergic granulomatous angiitis (AGA). Abdominal pain was present on day 10 after hospitalization, and computed tomography showed intraperitoneal free air, necessitating emergency surgery for intestinal perforation. Emergency laparotomy showed panperitonitis due to a perforated ulcer in the ileum 280 cm distal to the Treitz ligament. The skip lesions of mucosal disorder was noted 110 cm distal to the Treitz ligament and impending rupture of an ulcer was identified 140 cm from the Treitz ligament, necessitating ileostomy and intraperitoneal drainage. On the postoperative day (POD) 7, oral intake was started and the patient was discharged on POD 38. AGA in digestive organs complicated by perforation tends to be associated with a poor prognosis, making careful selection of operative procedure important.

Key words
allergic granulomatous angiitis, intestinal perforation

Reprint requests
Koji Maeda Department of Surgery, Jikei University Daisan Hospital
4-11-1 Izumi-Honcho, Komae, 201-8601 JAPAN

Accepted
November 19, 2008

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