Role of vasculitis in the natural history of abdominal tuberculosis--evaluation by mesenteric angiography.

To investigate the possible role of vascular changes in the pathogenesis of tubercular lesions of the abdomen, findings on barium studies of the bowel and superior mesenteric angiography in 20 patients with abdominal tuberculosis were correlated. Barium studies showed peritoneal lesions in seven patients, isolated intestinal lesions in seven and combined lesions in six. Angiograms were abnormal in all the patients and showed encasement of arteries (13 patients), stretching and crowding of vessels (13), occlusion of vasa recta (5) and hypervascularity (6). All the 13 patients with peritoneal lesions showed arterial stretching, crowding and encasement. Five of six patients with strictures had occlusion of vasa recta. Of seven patients with ulcerations, six had hypervascularity. Our observations suggest that vascular changes occur frequently in abdominal tuberculosis and may explain some pathological and clinical manifestations of this disease. Ulcerated and hypervascular lesions occur in the active and early stages of the disease, and occlusive lesions are associated with healing and 'ischemic' bowel strictures.