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Ischaemic necrosis of the small bowel in a case of malignant hypertension.

The radiological appearances of ischaemic necrosis due to vasculitis in the small bowel have been described by previous authors (Ettinger and Perez-Tamayo, 1957; Osborn and Friedland, 1973). In the early stages, the lumen is narrowed with mild rigidity. As the process advances, the folds become thickened, hazy and blunted. In severe cases there is diffuse ulceration and perforation may occur. Known aetiology of vasculitis includes collagen disease, thromboangiitis obliterans and microangiopathic haemolytic anaemia. The purpose of this report is to describe a case with radiologically demonstrable changes in the small bowel presenting as an acute abdomen, the final diagnosis being malignant hypertension. The histology is described. A 20-year-old male was admitted on March 6, 1974 to the Western Infirmary, Glasgow, with a six-week history of severe abdominal pain and steadily deteriorating vision in both eyes. He had a very tender abdomen, papilloedema, bilateral retinal detachment and a supine blood pressur...