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Complex presentation of polyarteritis nodosa: Renal pseudoaneurysm rupture and bowel ischemia: A case report

Year: 2025

Type: article

Abstract: INTRODUCTION: Polyarteritis Nodosa (PAN) is a rare vasculitis of medium-sized arteries with severe complications, including Renal artery aneurysm (RAA)rupture and gastrointestinal ischemia. Early recognition and intervention are crucial for improving outcomes. PRESENTATION OF CASE: A 21-year-old male with a history of PAN presented with acute flank pain, rash, confusion, and anemia. Imaging revealed a ruptured RAA with retroperitoneal hemorrhage. He developed bowel ischemia confirmed by colonoscopy and computed tomography scan. The patient underwent renal artery embolization and exploratory laparotomy, revealing gangrenous cecum and ileal perforation, requiring hemicolectomy and ileal resection. Postoperatively, he was treated with immunoglobulin, cyclophosphamide, and prednisone, resulting in significant improvement. DISCUSSION: PAN can cause life-threatening complications, including vascular rupture and ischemia. Embolization effectively controlled bleeding, and surgery addressed ischemic damage. Early intervention with immunosuppressive therapy played a key role in recovery. CONCLUSION: This case emphasizes the need for prompt recognition and treatment of severe PAN complications. Early surgical intervention and appropriate immunosuppressive therapy are essential for preventing fatal outcomes.

Source: International Journal of Surgery Case Reports

DOI: 10.1016/j.ijscr.2025.111172

Authors: Ali F. Rabaya, Kareem Ibraheem, Omar Shawer, Mutasem N. Nairat, Sayf Sayes, Rafiq Salhab