Yoshiya Keiji, Imamura Yu, Nakaji Yu, Taniguchi Daisuke, Takeda Rinne, Ando Koji, Nakashima Yuichiro, Shimizu Motohiro, Ohgaki Kippei, Furusyo Norihiro, Matsumoto Takuya, Saeki Hiroshi, Oda Yoshinao, Oki Eiji, Maehara Yoshihiko
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Fukuoka, Japan.
Department of Gastroenterological Surgery, the Cancer Institute Hospital of Japanese Foundation of Cancer Research, Tokyo, Japan.
Surg Case Rep. 2017 Dec;3(1):43. doi: 10.1186/s40792-017-0316-0. Epub 2017 Mar 13.
Polyarteritis nodosa (PAN) is a primary systemic necrotizing vasculitis with diffuse organ involvements, resulting in a high mortality rate due to multiple organ failure. Although the small bowel is the frequently targeted organ of PAN-associated vasculitis, rectal involvement is very rare, and only one case of rectal bleeding has been previously reported. The mortality rate of PAN with gastrointestinal (GI) perforation is reportedly much higher than that of without severe GI involvement. We herein report the first case of rectal perforation due to PAN, successfully managed with an adequate surgical intervention.
A 66-year-old woman with PAN had abdominal pain and melena with guarding. Computed tomography scan showed abdominal free air and bubbles in the rectal hematoma. We diagnosed it acute peritonitis, and emergency surgery was performed. After removing rectal hematoma and necrotic tissue, a huge lack of rectal wall spreading to the pelvirectal space was observed. In order to totally remove the necrotic tissue, abdominoperineal resection was needed. Together with histopathological examinations which showed neutrophils and fibrinous necrosis, we finally diagnosed rectal perforation due to PAN. At 19-month follow-up after surgery, she was still healthy with a stable disease of PAN.
We herein reported the first case of successfully managed rectal perforation due to PAN. Early adequate surgical resection may be important for the case with rectal perforation.
结节性多动脉炎（PAN）是一种原发性系统性坏死性血管炎，可累及多个器官，因多器官功能衰竭导致死亡率较高。尽管小肠是PAN相关血管炎常见的受累器官，但直肠受累非常罕见，此前仅报道过1例直肠出血病例。据报道，发生胃肠道（GI）穿孔的PAN患者死亡率远高于未发生严重GI受累的患者。我们在此报告首例因PAN导致直肠穿孔的病例，经适当的手术干预成功治愈。
一名66岁的PAN女性患者出现腹痛、黑便并伴有腹肌紧张。计算机断层扫描显示腹腔内有游离气体，直肠血肿内有气泡。我们诊断为急性腹膜炎，并进行了急诊手术。清除直肠血肿和坏死组织后，发现直肠壁有大片缺损并蔓延至直肠周围间隙。为了彻底清除坏死组织，需要进行腹会阴联合切除术。组织病理学检查显示有中性粒细胞和纤维蛋白样坏死，最终我们确诊为PAN导致的直肠穿孔。术后19个月的随访中，她病情稳定，身体健康。
我们在此报告首例成功治愈的因PAN导致的直肠穿孔病例。对于直肠穿孔病例，早期进行适当的手术切除可能很重要。
