Table 5.

Surgical and/or conservative therapy in 14 patients with gastrointestinal (GI) disease associated with GPA or MPA.

Patient No.GI Event Leading to Emergency InterventionType of InterventionOutcome
1Rectal bleeding, anemia9 blood/4 weeksDied 13 yrs later (renal failure)
21. Lower left abdom. pain, radiograph: free air. 2. Two weeks later, increasing SIRS, sigmoid perforation1. Laparotomy: sigmoiditis + localized purulent peritonitis, perforation not found. Ileostomy: drainage, no resection, abdomen closed. 2. Re-laparotomy: sigmoid perfor. but no diverticula. Hartmann sigmoid resection + colostomy, bowel rest, antibiotics, assisted ventilation, hemodialysis.Died 30 days later (multiorgan failure)
3Lower left abdom. pain, peritonitisLaparotomy: perforated sigmoid diverticulitis. Hartmann sigmoid resection + colostomyDied 24 days later (multiorgan failure)
41. Abdominal pain, peritonitis.
2. Abdominal pain
Laparotomy: Two perforations in ascending colon. Right hemicolectomy + ileocolic resection, primary anastomosisHealthy 2016
5Lower right abdom. painBowel rest, antibiotics, no blood transfusionHealthy 2016
6Abdom. pain; CT: hematomaArterial coiling, bowel rest, assisted ventilation, blood (no./1 day unknown)Healthy 2016
71. Abdom. pain, peritonitis.
2. Distended bowels, fever
1. Laparotomy: multiple small bowel perforations. Small bowel resection, prim. anastomosis, delayed closure of abdomen, bowel rest, antibiotics, assist. ventilation. 2. Re-laparotomy: no perforation, diffuse peritonitis, abdomen closed.Healthy 2016
8Rectal bleedingRight hemicolectomy, ileostomy, delayed abdom. closure, bowel rest, 12 blood/8 dDied 10 mos later (heart infarction)
9Abdom. pain, CT: free airLaparotomy: several ileocecal ulcers + perforations. Right hemicolectomia + dual-barrel ileo-/colostomy (not temporary), antibiotics, omeprazole, bowel rest.Healthy 2016
10Abdom. pain, CT: partial small bowel obstructionBowel restDied 5 yrs later (malignancy)
11Low abdom. pain, CT: abdom. abscessUS-guided drainage of sigmoid abscess, antibiotics, bowel restHealthy 2016
12Rectal bleeding, abdom. painAntibiotics, omeprazole, nasogastric draining, bowel rest, 12 blood/7 weeksHealthy 2016
13Rectal bleeding7 blood/8 weeks, omeprazole, bowel restHealthy 2016
14Rectal bleeding, abdom. pain2 blood/2 days, antibiotics, omeprazole, nasogastric draining, bowel restHealthy 2016
  • Time to death relates to months or years after start of GI symptoms. Blood refers to units of blood transfusion. US: ultrasound; GPA: granulomatosis with polyangiitis; MPA: microscopic polyangiitis; CT: computed tomography, SIRS: systemic inflammatory response syndrome.