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Incidentally discovered asymptomatic necrotising intra-abdominal vasculitis after peripheral gastric bypass surgery for morbid obesity
  1. A Bounas1,
  2. M Melachrinou2,
  3. G Giannopoulos1,
  4. N Meimaris1,
  5. P Aroukatos2,
  6. F Kalfarentzos3,
  7. A P Andonopoulos1
  1. 1Department of Medicine, Division of Rheumatology, University of Patras School of Medicine, Patras, Greece
  2. 2Department of Pathology, University of Patras School of Medicine, Patras, Greece
  3. 3Department of Surgery, University of Patras School of Medicine, Patras, Greece
  1. Correspondence to:
    Professor A P Andonopoulos
    Internal Medicine and Rheumatology, University of Patras School of Medicine, 265 00 Rio, Patras, Greece;

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We describe the case of a 35 year old woman, who underwent peripheral gastric bypass type Roux-Y surgery for morbid obesity, and was incidentally discovered to have diffuse abdominal necrotising vasculitis, which has remained silent for at least 15 months.


The patient was referred to us because a biopsy of the appendix removed at surgery had disclosed necrotising vasculitis (fig 1), and her serology had shown positive antinuclear antibodies (ANA), 1/320 homogeneous. She had received bronchodilators in the past, amoxicillin clavulanate, oral contraceptives, and fenfluramine for a short time. No recent vaccination had been administered. She denied systemic symptoms, arthralgias or arthritis, skin or mucosal lesions, abdominal pain or rectal bleeding, sicca symptoms, or Raynaud’s phenomenon. After surgery she had lost 45 kg and, as expected, she had been experiencing mild abdominal cramps and diarrhoea shortly after meals. Physical examination was normal.

Figure 1

Small artery …

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