Mesenteric Involvement in Giant Cell Arteritis. An Underrecognized Complication?: Analysis of a Case Series With Clinicoanatomic Correlation

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 Engli...

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Bibliographic Details
Published in:	Medicine (Baltimore) Vol. 87; no. 1; pp. 45 - 51
Main Authors:	Scola, Christopher J., Li, Cuizhen, Upchurch, Katherine S.
Format:	Journal Article
Language:	English
Published:	United States Lippincott Williams & Wilkins, Inc 01-01-2008
Subjects:	Aged Aged, 80 and over Blood Sedimentation Fatal Outcome Female Gastrointestinal Tract - blood supply Giant Cell Arteritis - complications Giant Cell Arteritis - pathology Humans Ischemia - etiology Male Mesenteric Artery, Inferior - anatomy & histology Mesenteric Artery, Inferior - pathology Mesenteric Artery, Superior - anatomy & histology Mesenteric Artery, Superior - pathology Mesenteric Vascular Occlusion - etiology Mesenteric Vascular Occlusion - pathology Retrospective Studies Splanchnic Circulation Temporal Arteries - pathology Vision Disorders
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Summary:	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.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	0025-7974
DOI:	10.1097/MD.0b013e3181646118