Connective tissue disease-induced gastrointestinal vasculitis: a clinical analysis of 14 cases

Investigate the clinical characteristics of connective tissue disease (CTD) patients with gastrointestinal vasculitis to improve diagnosis and treatment. Retrospective analysis of the clinical presentation, examination, testing, treatment and prognosis from 14 CTD patients with gastrointestinal vasculitis during a 12-years period. All 14 patients had clinical manifestations of gastrointestinal involvement and (or) symptoms. The most common clinical presentation was abdominal pain, followed by hemafecia. Laboratory tests showed positive fecal occult blood in 9 patients. Seven cases underwent endoscopy and nonsurgical medical treatment. Seven patients underwent surgical exploration, and were diagnosed intestinal necrosis in 3 cases, gastrointestinal perforation in 5 cases, peritonitis in 7 cases, intestinal obstruction in 3 cases and gastrointestinal ulcer in 7 cases. Histopathological examination identified significant neointimal hyperplasia, obliteration, and fibrinoid necrosis in the small blood vessels, or thrombosis. Six patients died, 4 during the surgery and 2 cases died during the nonsurgical treatment. CTD patients with gastrointestinal vasculitis showed unspecific symptoms, but had high mortality rate. Early diagnosis and prompt treatment can improve the prognosis. Positive fecal occult blood test can be considered as a warning sign, digestive endoscopy is the most direct method for early diagnosis.