Mesenteric arteritis is an unusual cause of mesenteric ischemia. However, it should be considered when locations are atypical such as the stomach, duodenum, rectum (small and large intestine involved at the same time), and the genitourinary system, especially in young patients 1.
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Epidemiology
The incidence of gastrointestinal tract vasculitis has been reported to be ~7.5% among non-atherosclerotic abdominal vascular diseases with a female predominance 4.
Clinical presentation
Along with clinical manifestations of systemic disease, vasculitis can have abdominal manifestations which vary according to the size and location of the affected vessels.
If large vessels are affected, its clinical manifestation will be similar to paralytic ileus and mesenteric ischemia from other etiologies. The involvement of medium-sized blood vessels may lead to inflammation, aneurysm formation, rupture, and consequently intraabdominal hemorrhage. Ulceration, stricture, and perforation can occur in small-vessel involvement 1.
Pathology
Vasculitis can involve large, medium, and small vessels 1:
- large vessel vasculitis, e.g. giant cell arteritis, Takayasu arteritis
- medium vessel vasculitis, e.g. polyarteritis nodosa, Behçet disease
- small vessel vasculitis, e.g. granulomatosis with polyangiitis
Radiographic features
CT
CT is the modality of choice and features include 1:
- features of mesenteric ischemia including bowel infarction
- ascites
- lymphadenopathy
- cystitis
- hydronephrosis secondary to fibrosis of urinary tract and spasm of detrusor muscles
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