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