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A Clinicopathological Study of Small Intestinal Perforations in Patients with Eosinophilic Granulomatosis with Polyangiitis
Sunday, March 6, 2016
South Exhibit Hall H (Convention Center)
Shin Saito, MD, PhD, Kentaro Kurashina, Shiro Matsumoto, Yasunaru Sakuma, Seiji Minota, Masahiro Iwamoto, Daisuke Matsubara, Noriyoshi Fukushima, Hisanaga Horie, Yoshinori Hosoya, Alan K Lefor, Naohiro Sata
Rationale:

Eosinophilic granulomatosis with polyangiitis (EGPA) is a vascular disorder of unknown etiology characterized by severe asthma, eosinophilia, and granulomatous vasculitis. It is sometimes associated with gastrointestinal lesions, although perforations are uncommon.

Methods:

From January 1st 2001 to December 31st 2014, 71 patients underwent operation for small intestinal perforations. Among them, four operations had been performed in three patients with EGPA, who were treated with corticosteroids at the time of presentation. We retrospectively reviewed the clinical and pathological features of these patients.

Results: The three patients with EGPA were men, with a mean age of 56 years. The length of resected intestine ranged from 10-60 cm. Histopathological examination revealed ulcers and perforations of the small intestine associated with vasculitis, compatible with EGPA. All patients had an uneventful postoperative course.

Conclusions: Corticosteroids are commonly used for controlling EGPA, however they may induce fibrotic changes in the intimal tissue resulting in perforation.  Abdominal pain is reported in up to 29–59% of patients with EGPA and gastrointestinal perforations are responsible for up to 10% of EGPA-associated deaths. Patients with EGPA suffering from abdominal pain must be evaluated for their intestinal perforations carefully, especially while undergoing treatment with corticosteroids.