Clinical Features, Morbidity, and Risk Factors of Intestinal Pseudo-obstruction in Systemic Lupus Erythematosus: A Retrospective Case-control Study

Abstract

IPO is a rare complication, but commonly presents as the initial affected system of SLE, which can lead to a difficult diagnosis and delayed treatment. SLE-IPO occurrence concomitantly with pyeloureterectasis and megacholedochus showed a severe clinical situation in our cohort. Thus, patients with SLE-IPO with systemic smooth muscular involvement should be diagnosed early and treated aggressively.

Lupus causing small bowel obstruction

“…IPO is a rare GI manifestation SLE4 with less than 40 cases published in the English literature and is characterised by signs and symptoms of mechanical bowel obstruction, affecting small or large bowel and often without radiological signs of mechanical obstruction. In a retrospective case–control study performed by Zhang et al ,5 the prevalence of IPO in patients with SLE is 1.96% with an in-hospital mortality rate of 7.1%. Also some reports suggest a female preponderance with a mean age of presentation of 40 6.…”

Lupus intestinal pseudo-obstruction and hydronephrosis

“…[1] SLE-IPO is a relatively rare entity that is likely underdiagnosed. In one recent series of hospitalized patients with SLE, the prevalence of lupus intestinal pseudo-obstruction (SLE-IPO) was approximately 2% [2] and SLE-IPO encompasses about 5% of all cases of SLE-induced abdominal pain requiring admission to the hospital. [3] SLE-IPO clinically manifests as abdominal pain and distension, nausea and emesis, constipation, and/or diarrhea.…”

“…There is a striking association between intestinal pseudo-obstruction in SLE and genitourinary (GU) complications including hydronephrosis, hydroureter, and cystitis. [7] Approximately, 60% of SLE patients with IPO also have coinciding ureterohydronephrosis, [2,8] and among these patients many have reduced bladder capacity and histologic evidence of interstitial cystitis. [7,9–11] SLE-interstitial cystitis can often be distinguished histologically from idiopathic interstitial cystitis by the presence of immunofluorescent deposits in blood vessel walls of the urinary bladder.…”

“…[10,12] Gall bladder wall thickening, biliary and pancreatic duct dilation, and esophageal dysmotility are also associated findings with SLE-IPO. [2,13–15] Concurrent involvement of the gastrointestinal (GI) and GU tracts in SLE should strongly raise suspicion for intestinal pseudo-obstruction. [16]…”

“…IPO can occur at any time during the disease course of SLE, and in two-thirds of cases it can be a presenting symptom of SLE. [2] SLE-IPO is especially challenging to diagnose when IPO develops before an underlying diagnosis of SLE is established. IPO typically occurs in active SLE, although there are reports of IPO in patients with quiescent disease.…”