J Rheum Dis.  2015 Dec;22(6):378-381. 10.4078/jrd.2015.22.6.378.

A Case of Ischemic Enteritis with Small Bowel Perforation during Management of Lupus Enteritis

• Joo SH
• Lee JM
• Park JK
• Lee EY
• Lee EB
• Song YW

• KMID: 2222812
• DOI: http://doi.org/10.4078/jrd.2015.22.6.378

Abstract

Development of ischemic enteritis is rare in patients with systemic lupus erythematosus (SLE). We report on a case of ischemic enteritis with small bowel perforation in a 54-year-old female patient with SLE. She was diagnosed as SLE at 20 years old. Nine months ago, she developed periumbilical pain and was diagnosed with lupus enteritis. She was treated with prednisolone (0.5 mg/d), which was tapered gradually over 6 weeks. Prednisolone was maintained at 12.5 mg once a day. A similar periumbilical pain episode occurred again 7 months ago. Four weeks ago, she visited the emergency room due to diffuse abdominal pain, and abdominal computed tomography showed small bowel obstruction. Gastrointestinal manifestations improved after conservative management. She visited again due to severe abdominal pain for 2 days. She had panperitonitis due to a small bowel perforation and underwent an emergency laparotomy. The surgical specimen revealed ischemic enteritis involving whole bowel wall thickness with perforation. We report on a case of ischemic enteritis with small bowel perforation in a SLE patient diagnosed as lupus enteritis with literature review.

Keyword

Systemic lupus erythematosus; Ischemic enteritis; Intestinal perforation

MeSH Terms

Abdominal Pain
Emergencies
Emergency Service, Hospital
Enteritis*
Female
Humans
Intestinal Perforation
Laparotomy
Lupus Erythematosus, Systemic
Middle Aged
Prednisolone
Prednisolone

Figure

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  Figure 1. (A) Plain radiograph of abdomen shows gaseous bowel distention. (B) Computed tomography (CT) of abdomen shows small bowel obstruction with marked dilatation, focal enhancing soft-tissue density infiltration of mesentery with small ascites and focal wall thickening at the transition zone (arrow head). But, free air was not observed in Figure 1A or 1B. (C) Eight weeks prior to surgery, CT of abdomen showed bowel edema with mild perienteric infiltration at the mesenteric side of multifocal distal small bowel, ascending colon, sigmoid colon and rectum.

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  Figure 2. (A) Resected small intestine shows focal dark-red colored ischemic enteritis in jejunum (arrowheads). Microscopic finding shows ischemic enteritis with moderate full-thick-ness transmural inflammatory cell infiltration, suggestive of chronic inflammation (B) and bowel perforation with sub-mucosal/subserosal inflammatory cell infiltration, hemorrhage and congestion (arrowheads) (H&E, X40).

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