Intestinal vascular lesions simulating polyarteritis nodosa after resection of coarctation of the aorta.

it is only recently that mesenteric arterial necrosis, causing severe abdominal symptoms, has been recognized as a post-operative complication after resection of coarctation of the aorta. The first recorded case was mentioned briefly in a report by Sealy (1953) and later presented in detail, together with another similar case, by Benson and Sealy (1956). Two further cases, with lesions indistinguishable from periarteritis nodosa, were reported by Lober and Lillehei (1954), and another by Perez-Alvarez and Oudkerk (1955). No other cases have been reported in the literature, although Ring and Lewis (1956) have reviewed a series of 18 patients in whom abdominal symptoms of varying intensity occurred as a marked feature during the post-operative period. Cleland, Counihan, Goodwin, and Steiner (1956) have also reported the occurrence of severe post-operative abdominal pain in five out of a series of 40 cases of coarctation treated surgically, but came to no conclusion as to the cause of the pain. Patients who develop abdominal pain after a resection of a coarctation of the aorta may be treated on a more rational basis if it is recognized that this pain, which can be severe and of sufficient severity to simulate an acute abdominal emergency, may be due to arterial necrosis. The condition also has added significance in relation to the role of haemodynamics in the aetiology of polyarteritis nodosa and related arterial diseases. For these reasons a further case with striking pathological changes is presented in this paper.