[Vasculitis-related acute abdomen in systemic lupus erythematosus--ultrasound appearances in lupus patients with intra-abdominal vasculitis].
Although an acute abdomen often occurs in lupus patients, definitive treatment is commonly delayed due to the difficulty in diagnosis. We performed an abdominal ultrasound (US) in two patients with severe abdominal pain and recognized mural thickenings of intestinal walls. In the first case high dose prednisone was given for severe abdominal pain, with subsequent perforation of sigmoid colon. Pathological specimens showed a thrombotic vasculitis in the mesenteric artery and arteriole of intestinal walls. In the second case physical examination elicited a rebound tenderness. An abdominal X-ray demonstrated a gasless ileus and US also showed marked thickening of intestinal walls, 16 mm in thickness. A CT scan revealed the same findings in the entire bowel. After high dose methylprednisolone was administered, her symptoms markedly improved. The mural thickenings disappeared within 10 days as seen by abdominal ultrasound examination. The US is very useful in order to make an early diagnosis of intestinal vasculitis, showing as edema (but non-specific) of intestinal wall and we can use it safely and repetitively without exposure to radiation, compared with other examinations, such as CT scan and gastrointestinal contrast study etc. The US is not only useful in diagnosis, but also helpful for follow up of patients after the initiation of treatment.
Shiohira
Y
Y
Department of internal Medicine, Okinawa Chubu Hospital.
Uehara
H
H
Miyazato
F
F
Matsumoto
H
H
D000005:Abdomen / Q000000981:diagnostic imaging; D000006:Abdomen, Acute / Q000000981:diagnostic imaging / Q000209:etiology*; D000328:Adult; D005260:Female; D006801:Humans; D007422:Intestines / Q000098:blood supply*; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D011237:Predictive Value of Tests; D014463:Ultrasonography; D014657:Vasculitis / Q000150:complications* / Q000000981:diagnostic imaging