Multiple Transverse Colonic Perforations Associated with Slow-Release Nonsteroidal Anti-Inflammatory Drugs and Corticosteroids: A Case Report

Abstract

The patient was a 36-year-old woman with sarcoidosis and Sjogren's syndrome, and had been prescribed slow-release diclofenac sodium and prednisolone for the treatment of pain associated with uveitis and erythema nodosum. She was admitted to our emergency center with abdominal pain and distention. A chest X-ray showed free air under the diaphragm on both sides, and an emergency laparotomy was performed for suspected panperitonitis associated with intestinal perforation. Laparotomy revealed several perforations on the antimesenteric aspect of the transverse colon. The resected specimen showed 11 punched-out ulcerations, many of which were up to 10 mm in diameter. The microscopic findings were non-specific, with leukocytic infiltration around the perforations. She showed good postoperative recovery, as evaluated on day 42. The present case highlights the need for exercising caution while prescribing slow-release nonsteroidal anti-inflammatory drugs with corticosteroids to patients with autoimmune diseases, as such treatment may exacerbate intestinal epithelial abnormalities.

Erythema nodosum in rheumatic diseases

“…Так, N. Shioya с соавт. представляют 36-летнюю женщину с синдромом Шегрена, саркоидозом, увеитом и УЭ, которая принимала глюкокортикоиды (ГК) и нестероидные противовоспалительные препараты [22]. В работе японских авторов развитие УЭ предшествовало появлению клинической симптоматики синдрома Шегрена у трех из четырех наблюдавшихся больных [23].…”

Nonsteroidal anti-inflammatory drugs: An unusual cause of multiple ileal perforations

“…It is proven that NSAIDs can be harmful to the small intestine and can be associated with multiple complications, such as, small intestinal strictures, ulcerations, perforations, diarrhea, and villous atrophy. The NSAIDs can have adverse effects in any part of the gastrointestinal tract including, oesophagus, stomach, duodenum, small intestine, or colon [2,3]. Risk is increased with age, in first three months of treatment, smoking, associated cardiovascular or respiratory disease, high dose and multiple NSAIDs, and concomitant use of anticoagulant or steroids [1,3].…”