Periarteritis nodosa was first accurately described by Kussmaul and Maier1 in 1866. Since that time, many detailed case reports have appeared in journals devoted to pathology or to internal medicine. The frequency with which this disease simulates acute conditions requiring surgical treatment justifies its emphasis in the surgical literature.
Periarteritis nodosa or, better, polyarteritis nodosa, is primarily a disease process involving the walls of blood vessels. The lesions start with edema and subsequent necrosis in the media of the vessel wall. The process ultimately extends to the intima, with reactive cellular proliferation which frequently produces endothelial injury and thrombus formation. There is also an adventitial infiltration of polymorphonuclear leukocytes, often accompanied by eosinophils. The healing process with the laying down of connective tissue results in the formation of a nodule involving the vessel wall; lack of repair, mural degeneration and necrosis with destruction of elastic fibers may terminate in