Recurrent small bowel infarction in a young man: polycythaemia or vasculitis?

Abstract

A 29-year-old man presented with a 3 day history of right lower quadrant pain, nausea and vomiting. There was tenderness in the right lower quadrant. At surgery the appendix was normal but an infarcted terminal ileum segment was found and resected. Histopathological examination was suggestive of vasculitis. The patient was discharged in good condition and follow-up for the first year was unremarkable. Unfortunately he developed another episode of bowel ischaemia in the second year and underwent resection of a short segment of proximal ileum. An autoimmune profile was negative. However, subsequent blood tests confirmed polycythaemia. Small bowel infarction due to polycythaemia in a young patient is rare and may be difficult to diagnose on clinical grounds.

Duodenal perforation in an adult with uncorrected Tetralogy of Fallot

“…7 Amongst these, the incidence and likely causes of gastrointestinal perforation in adults with TOF cannot be accurately assessed due to unavailability of data. Although one study highlighted the possibility of mesenteric ischemia due to polycythemia 8 while another discussed the likelihood of false negative H. pylori testing that is commonly encountered, particularly with tests that depend upon the number of organisms (including the stool antigen test) when the patient is taking concurrent antibiotics, proton pump inhibitors, or bismuth. 9 Generally PUD is considered the most prevalent cause of ulceration and perforations encountered in recent times.…”