Document Detail


Mesenteric involvement in giant cell arteritis. An underrecognized complication? Analysis of a case series with clinicoanatomic correlation.
MedLine Citation:
PMID:  18204370     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We reviewed the clinical manifestations of mesenteric vasculitis due to giant cell arteritis (GCA) and considered features of the mesenteric anatomy in relationship to disease expression. We compiled and reviewed a case series by systematic identification of patients previously reported in the English-language literature to have mesenteric involvement from known GCA. Included in the analysis was a detailed case review of a patient with GCA and small bowel infarction seen at our institution. Twelve patients were identified with mesenteric ischemia attributed to GCA. Concomitant cranial and abdominal symptoms were present in 7 of the 12 patients, and cranial symptoms were absent in 5 patients who presented with abdominal complaints. The abdominal symptoms fell within a spectrum ranging from chronic postprandial symptoms to acute abdominal pain. Survival was observed in only 6 of the 12 cases, 3 of whom required bowel resection and were treated with high-dose corticosteroids. Review of the anatomic features of the specialized splanchnic circulation reveals an extensive collateral network that may protect against early disease expression from ischemia, despite mesenteric arteritic involvement. Mesenteric vasculitis resulting in small bowel infarction has only rarely been described in GCA but represents a serious and potentially treatable complication. We propose an explanation, based on mesenteric vascular anatomy, for the infrequency of symptomatic expression of this entity and suggest that occult mesenteric GCA may be present far more often than recognized.
Authors:
Christopher J Scola; Cuizhen Li; Katherine S Upchurch
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Medicine     Volume:  87     ISSN:  0025-7974     ISO Abbreviation:  Medicine (Baltimore)     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-01-21     Completed Date:  2008-03-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2985248R     Medline TA:  Medicine (Baltimore)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  45-51     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, Division of Rheumatology, University of Massachusetts School of Medicine, UMass Memorial Medical Center, 116 Belmont Street, Worcester, MA 01605, USA. scolac@ummhc.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Blood Sedimentation
Fatal Outcome
Female
Gastrointestinal Tract / blood supply
Giant Cell Arteritis / complications,  pathology*
Humans
Ischemia / etiology*
Male
Mesenteric Artery, Inferior / anatomy & histology,  pathology*
Mesenteric Artery, Superior / anatomy & histology,  pathology*
Mesenteric Vascular Occlusion / etiology,  pathology*
Retrospective Studies
Splanchnic Circulation*
Temporal Arteries / pathology
Vision Disorders

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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