Slovenská chirurgia 4/2013

Vasculitis of colon ascendens as a cause of peritonitis

Systematic vasculitis is characterized by vascular inflammation of the venules, capillaries, and/or arterioles with pleomorphic clinical manifestations. Diagnostic is based on sampling of affected part of bowel, which reveals angiocentric segmental inflammation, fibrinoid necrosis, and a neutrophilic infiltrate around the blood vessel walls with erythrocyte extravasation. Affection of gastrointestinal tract with the mesenteric ischemia is rare. Patients with small-vessel and medium-vessel vasculitides, and noted extremely high mortality rates and depressed 5-year and 10-year survival rates post abdominal surgery in patients with necrotizing vasculitides. We report a case of systematic vasculitis of gastrointestinal tract with incidental frequency in the literature. Seventy years old woman with nausea, vomiting and peritoneal irritation was admitted to the hospital. Gangraena of coecum and colon ascendens was found during surgery. Patient underwent right hemicolectomy and after three weeks she was admitted with similar symptoms to the hospital again. The cause of illness was ischemic colitis of sigmoid bowel, which was treated with antibiotics. After steroid therapy she was discharged with significant improvement.

Keywords: necrotizing vaskulitis, gastrointestinal tract, surgical treatment.