Intestinal Pseudo-Obstruction in Systemic Lupus Erythematosus

Abstract

Intestinal pseudo-obstruction (IPO) is a rare but dangerous complication of systemic lupus erythematosus (SLE) when the patient has no other manifestations except gastrointestinal symptoms. We performed 1 patient with a 2-month history of recurrent vomiting and abdominal distension. She admitted past surgical histories of cesarean section and appendectomy. A physical examination revealed tenderness in the right lower abdominal on palpation and bowel sounds were weak, 2 to 3 bpm. An x-ray and CT of her abdomen showed intestinal obstruction. The initial diagnosis was adhesive intestinal obstruction. She received surgical treatment because her symptoms had gradually become more frequent and persistent. But she vomited again 2 weeks later after the surgery. Further immunology tests indicated that she had an IPO secondary to SLE. We treated the patient with methylprednisolone pulse for 3 days and followed by prednisone orally. The patient had a good response. Complete remission was achieved on 8 years follow-up.The importance of IPO secondary to SLE lies in an early diagnosis. After the diagnosis is established, immunosuppressive therapy should be the initial and first-line treatment, and surgical intervention is often disappointing and should be carefully avoided. It is necessary to enhance awareness of doctors to IPO secondary to SLE.

Gastrointestinal and Hepatic Disease in Systemic Lupus Erythematosus

“…Follow-up endoscopy frequently does not reveal a specific structural cause of the obstruction. 16 As was mentioned above, the lower third of the esophagus, the gastric antrum, and duodenum are particularly susceptible to pseudo-obstruction.…”

“…Typical involvement implicates not only the smooth muscle, but also involves the enteric nerves, leading to visceral autonomic nervous system dysfunction, further compromising GI motility. 16 Patients are subject to an increased risk of developing urinary tract infections. However, urinary tract infections can also be associated with impaired gastric motility independently of intestinal pseudo-obstruction.…”

Intestinal pseudo‐obstruction: Unusual presentation of systemic lupus erythematous

“…It could be due to intestinal vasculitis affecting visceral smooth muscles or to autoantibodies targeting smooth muscle with immune complex deposition on the muscle and/or nerve, explaining gut dismotility disorder during SLE. 3 The diagnosis of IPO is made based on clinical signs, air-fluid levels, and bowel dilatation, with or without bowel wall thickening in imaging. Esophagogastroduodenoscopy, colonoscopy, and abdominal CT scan are performed to exclude mechanical obstruction.…”

Lupus causing small bowel 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. It usually occurs in patients with active SLE but may also be the initial presentation 7.…”