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1/15. Acute abdomen and lupus enteritis: thrombocytopenia and pneumatosis intestinalis as indicators for surgery.

    Bowel symptoms occur often in systemic lupus erythematosus (SLE), but enteric complications in patients on steroid therapy are rare. We report a case of a 14-year-old Mexican girl with SLE on high-dose steroid therapy complicated by abdominal vasculitis and small bowel perforation. Accompanying this serious complication were thrombocytopenia and radiographic changes of pneumatosis intestinalis. These findings suggested necrotizing enteritis and prompted urgent surgery. Four jejunal perforations, pneumatosis intestinalis, and submucosal vasculitis were present in the resected specimen. Persistent SLE activity responded to cyclophosphamide, which is indicated in patients with digestive symptoms who fail to respond to high-dose steroids.
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ranking = 1
keywords = vasculitis
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2/15. Lupus abdominal crisis owing to rupture of an ileocolic aneurysm with successful angiographic treatment.

    There are many causes of acute abdominal pain, or abdominal "crises," in patients with systemic lupus erythematosus (SLE), most frequently the causes are serositis or vasculitis. Vasculitis generally causes small vessel abnormalities and may present with symptoms owing to mucosal damage, such as pain, diarrhea, or bleeding. We present a patient with SLE who had the acute onset of severe abdominal pain while hospitalized for a lupus flare and who was found to have a ruptured ileocolic aneurysm with intraperitoneal bleeding. She was successfully managed with angiographic embolization, without further complications. Although angiography is well established as a therapeutic intervention for mesenteric aneurysms of various etiologies, this is the first case of an SLE-related ileocolic aneurysm so managed. This entity should be considered in the differential diagnosis of abdominal pain in patients with lupus, and angiographic embolization should be considered in its management.
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ranking = 0.5
keywords = vasculitis
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3/15. Laparoscopically assisted treatment of acute abdomen in systemic lupus erythematosus.

    The incidence of abdominal pain in patients with systemic lupus erythematosus (SLE) is very high. Most patients do not require surgical treatment (serositis). Some cases such as appendicitis, perforated ulcer, cholecystitis or, rarely, intestinal infarction are surgical. Differential diagnosis is difficult, partly because noninvasive examinations do not provide enough evidence to rule out a diagnosis. On the other hand, in patients with SLE who have acute abdomen, it is dangerous to delay surgery by attempting conservative therapy. In fact, a better survival rate has been associated with early laparotomy. We report a case of acute abdomen in a patient affected by SLE, in which the diagnostic problem was solved by means of laparoscopy and the treatment was laparoscopically assisted. A 45-year-old woman with a 25-year history of SLE was admitted with abdominal pain and fever. Her physical examination revealed a painful right iliac fossa with rebound tenderness. Her WBC count was normal. Abdominal x-ray, ultrasonography, paracentesis, and peritoneal lavage did not provide a diagnosis. A diagnostic laparoscopy was performed, showing segmentary small bowel necrosis. The incision of the umbilical port site was enlarged to allow a small laparatomy, and a small bowel resection was performed. The histopathologic finding was "leucocytoclasic vasculitis, with infarction of the intestinal wall." The patient recovered uneventfully. In conclusion, this case report shows that emergency diagnostic laparoscopy is feasible and useful for acute abdomen in SLE. Currently, this diagnostic possibility could be considered the technique of choice in these cases, partly because, when necessary, it also can allow for mini-invasive treatment therapy.
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ranking = 0.5
keywords = vasculitis
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4/15. Intestinal ischemia as the first manifestation of vasculitis.

    OBJECTIVE: To summarize current knowledge regarding the diagnosis and management of gastrointestinal vasculitis. methods: Three cases of gastrointestinal vasculitis with acute abdominal ischemia as their first manifestation are presented. Underlying diseases were microscopic polyangiitis, systemic lupus erythematosus (SLE), and polyarteritis nodosa (PAN). Relevant English-language articles collected from the pubmed database were reviewed. RESULTS: Among the angiitides, PAN, SLE, and Henoch-Schonlein are those most commonly accompanied by gastrointestinal complications. Intestinal vasculitis usually occurs when there is evidence of generalized disease activity. Abdominal computerized tomography is a valuable tool for diagnosing intestinal ischemia and suspected vasculitis. CONCLUSIONS: In young patients presenting with intestinal ischemia, it is essential to assess the possibility of an underlying systemic disease. With prompt initiation of immunosuppressive treatment, surgery may be avoided. prognosis is improved when there is minimal delay in surgical intervention.
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ranking = 4.001763626199
keywords = vasculitis, angiitis
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5/15. A rare case of splenic infarct presenting with acute abdominal pain due to polyarteritis nodosa: case report and review of the literature.

    A 44 year-old man presented to the Emergency Department of American Hospital with severe pain persisting in the left upper quadrant for several hours. A computed tomographic scanning (CT scan) and celiac digital substraction angiography (DSA) of the abdomen demonstrated a splenic infarct. Histopathological examinations showed diffuse acute vasculitis, thrombosis, panvasculitis which led us to diagnose the case as "polyarteritis nodosa". The diagnosis is usually difficult to establish and it is usually delayed due to variable clinical manifestations dependent on the site and the extent of arterial involvement.
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ranking = 1
keywords = vasculitis
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6/15. polyarteritis nodosa. An unusual cause of acute abdomen.

    Two cases of acute abdomen operated on twice and biopsy specimens confirmed are presented. The diagnosis of a systemic necrotizing vasculitis group of polyarteritis nodosa was established. The syndrome affects predominantly males between the second and forth decade of life. The gastrointestinal tract is involved in approximately 50% of the cases. While a negative laparotomy may be considered as a surgical pit-fall, nevertheless, it is the only way of establishing the diagnosis and treating the complications of the disease in some of the cases.
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ranking = 0.5
keywords = vasculitis
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7/15. A case of vasculitic cholecystitis associated with Schonlein-Henoch purpura in an adult.

    A case of Schonlein-Henoch purpura (SHP) in a 32 year-old female, showing gastrointestinal manifestations including acute vasculitic cholecystitis was reported. In the course of hospitalization urgent laparotomy was performed because of the severe abdominal pain. The gallbladder was inflamed with a brownish-red edematous wall and subserosal hemorrhage, and was resected. Histological examination of the resected gallbladder specimen revealed leucocytoclastic vasculitis. The patient was treated with prednisolone postoperatively, and symptoms abated over two weeks. Acute cholecystitis with SHP is extremely rare, and as far as the authors know this is the second case of this disorder documented by histological examination. patients with acute abdomen associated with SHP should be managed with consideration of the complications of acute cholecystitis.
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ranking = 0.5
keywords = vasculitis
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8/15. Acute abdomen in rheumatoid arthritis due to mesenteric arteritis. A case report and review.

    A 69-year-old woman with seropositive rheumatoid arthritis since the age of 54 developed severe abdominal pain, and laparotomy was performed. Due to perforation of the ileum, there was generalised peritonitis. The histological examination showed mesenteric rheumatoid arteritis. Only a few cases like this are described in the literature. Most of the patients were males, and the mortality was high. When a patient with rheumatoid arthritis develops abdominal pain, mesenteric arteritis may be the cause. No definitive therapy is available, but prompt surgical intervention followed by anticoagulants has been recommended. For the treatment of rheumatoid vasculitis as such, corticosteroids in high doses, cyclophosphamide and plasma exchange have been used separately with beneficial effects.
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ranking = 0.5
keywords = vasculitis
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9/15. Upper gastrointestinal endoscopy in systemic vasculitis presenting as an acute abdomen.

    Three cases of upper gastrointestinal vasculitis presenting as acute abdominal emergencies highlight an uncommon but often fatal presentation of systemic vasculitis. Although abdominal symptoms are common in such diseases, there may be a doubt during assessment of the patient as to whether the gastrointestinal tract is the prime target organ. radiology is often negative during the acute illness. endoscopy was important in documenting early and more advanced bleeding lesions of polyarteritis nodosa (PAN) and Henoch-Schoenlein disease, both conditions in which upper gastrointestinal lesions are rare. The gastric and duodenal vasculitic lesions demonstrated by endoscopy in such a clinical setting were confirmed histologically. Endoscopic assessment and early aggressive medical therapy contributed significantly towards the overall successful outcome. Gastroduodenoscopy has not been used either routinely or as an emergency investigation for the assessment of patients with vasculitis who present with acute abdominal pain. Involvement of the stomach and duodenum by vasculitis is therefore poorly appreciated, but remains a serious complication of vasculitic disease when the gastrointestinal tract is the prime target organ, and the information gained by endoscopy in a difficult clinical situation might alter the overall outcome of the disease.
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ranking = 4
keywords = vasculitis
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10/15. Acute abdominal complications of systemic lupus erythematosus.

    Four patients with acute abdominal complications of systemic lupus erythematosus requiring laparotomy are presented. The complications consisted of intestinal ischaemia, without perforation, in 3 patients and omental infarction in the fourth. In 2 patients the abdominal emergency was the first manifestation of the collagen disease. Tissue removed from 3 patients showed a marked vasculitis on histological examination. The pathogenesis and management of acute abdominal complications of systemic lupus erythematosus are discussed and the literature reviewed.
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ranking = 0.5
keywords = vasculitis
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