Jejunal perforation complicating dermatomyositis

Lee, Donghyoun; Jeong, Wooseong; Hyun, Chang Lim; Kim, Jinseok

doi:10.1016/j.ijscr.2019.04.010

Cited by 3 publications

(8 citation statements)

References 13 publications

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“…It is also important to note that when the endoscopists resected the polyps, they felt that the polyps were resected more easily than usual, possibly indicating weakness of the intestinal wall. However, other reports describe perforations that might have been caused by tissue ischemia, such as vasculitis 9,10 . In our case, vasculitis was found in the resected specimen, although no thinning of or abscesses within the intestinal wall existed.…”

Section: Discussioncontrasting

confidence: 44%

“…However, other reports describe perforations that might have been caused by tissue ischemia, such as vasculitis. 9,10 In our case, vasculitis was found in the resected specimen, although no thinning of or abscesses within the intestinal wall existed. The presence of vasculitis might have been one of the causes of the perforation.…”

Section: Discussionmentioning

confidence: 46%

“…We experienced a case of delayed perforation from CSP in a corticosteroid‐treated patient with vascular fragility and the presence of vasculitis. It is possible that some patients on corticosteroid therapy may have a special pathology, such as that of this case, sigmoid colon perforation, 9 or jejunal perforation, 10 but it is difficult to confirm in advance whether all patients undergoing colonoscopy have a possible special pathology. To avoid such rare adverse events, clinicians should be wary of patients undergoing corticosteroid therapy.…”

Section: Discussionmentioning

confidence: 99%

“…The authors reasoned that the perforation was due to intestinal ischemic changes. 10 Another case report of CSP perforation in a corticosteroid‐treated patient described no significant histological findings, such as thinning or weakness of the intestinal wall, but they found focal microbleeding in the polyp. 4…”

Section: Discussionmentioning

confidence: 99%

“… 8 Other reports describe perforations that might have been caused by tissue ischemia, such as vasculitis. 9 , 10 A case of unusual jejunal perforation in a patient undergoing corticosteroid treatment described marked hemorrhage and necrotic changes in the mucosa and hemorrhage and inflammatory exudates in the serosa at the perforation site. In that case, pathologic examination of the intestinal vessels showed mesenteric small‐vessel vasculitis and vascular thrombosis with perivascular inflammatory cell infiltration.…”

Section: Discussionmentioning

confidence: 99%

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Delayed perforation after cold snare polypectomy for small colonic polyps in a patient receiving oral corticosteroids

et al. 2022

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This case report describes a fatal outcome due to delayed perforation after cold snare polypectomy in a patient with bullous pemphigoid receiving oral corticosteroids. Cold snare polypectomy has become the standard treatment for small colorectal polyps because of the procedure's safety and simplicity. In this case, however, corticosteroid therapy and vasculitis may have caused local necrosis and tearing of the intestinal wall. Corticosteroids are widely used, and perforation after cold snare polypectomy is extremely rare. However, some patients on corticosteroid therapy may have special pathologies, such as in this case, and we advise physicians to use appropriate judgment and extreme caution in determining the indication for endoscopic therapy.

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Section: Discussioncontrasting

confidence: 44%

Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Delayed perforation after cold snare polypectomy for small colonic polyps in a patient receiving oral corticosteroids

et al. 2022

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Pneumatosis cystoides intestinalis in dermatomyositis: a case series report and literature review

Zhang

Lü

2023

Front. Immunol.

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Pneumatosis cystoides intestinalis (PCI) in adult dermatomyositis (DM) is rarely described. This report aimed to describe the clinical features and prognosis of PCI in six adult patients with DM (four with anti-MDA5 antibodies, one with anti-SAE antibodies, and one with anti-TIF-1γ antibodies). Except for one patient with transient abdominal pain, the remaining five patients were asymptomatic. PCI occurred in the ascending colon in all patients, of whom five had free gas in the abdominal cavity. No patients received excessive treatment, and PCI disappeared in four patients during the follow-up. Additionally, we reviewed previous studies on this complication.

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Gastrointestinal Involvement in Dermatomyositis

et al. 2022

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Dermatomyositis is a systemic vasculopathy mainly affecting skin, muscle and lung, but may affect the gastrointestinal tract. We aim to describe clinical characteristics of patients with severe gastrointestinal involvement related to dermatomyositis in our center and medical literature. We retrospectively analysed these patients in our center, including cases of erosions/ulcers, perforation or digestive bleeding. Reported cases from April 1990 to April 2021 were reviewed through PubMed and Cochrane. From our cohort (n = 188), only 3 presented gastrointestinal compromise. All were women (10, 46 and 68 years). The initial symptom was abdominal pain and all had ≥2 episodes of digestive bleeding. All died due to complications of gastrointestinal involvement. Available pathological samples showed vascular ectasia. From the literature review (n = 50), 77% were women with a mean age of 49 years and the main symptom was abdominal pain (65%). All presented active muscular and cutaneous involvement at complication diagnosis. Mortality was 41.7%. The underlying lesion was perforation or ulcer (n = 22), intestinal wall thickening (n = 2), macroscopic inflammation (n = 2) or intestinal pneumatosis (n = 15). In 13 cases, vasculitis was described. Gastrointestinal involvement in dermatomyositis denotes severity, so an early intensive treatment is recommended. Pathological findings suggest that the underlying pathophysiological mechanism is a vasculopathy and not a true vasculitis.

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Jejunal perforation complicating dermatomyositis

Cited by 3 publications

References 13 publications

Delayed perforation after cold snare polypectomy for small colonic polyps in a patient receiving oral corticosteroids

Delayed perforation after cold snare polypectomy for small colonic polyps in a patient receiving oral corticosteroids

Pneumatosis cystoides intestinalis in dermatomyositis: a case series report and literature review

Gastrointestinal Involvement in Dermatomyositis

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