A Case of SLE Patient with Intestinal Perforation because Adrenal Cortex Steroids are Orally Administered

Masaki Hata, Tsutomu Maeda, Tetsuro Yamamoto, Masayuki Kitajima, Shinji Kasamaki, Tomoo Watanabe, Yoshiro Ishibiki, Seiya Hosoda, Kazuhiro Sakamoto and Toshiki Kamano

Department of Coloproctological Surgery, Juntendo University School of Medicine

The patient was a 55-year-old female. When the patient developed SLE at the age of 33 years, adrenal cortex steroids were orally administered. The patient suddenly had pain in the lower abdomen. Since free air and a mass in the abdomen were detected by abdominal CT, perforation in the digestive tract was diagnosed, and laparotomy was performed. Retention of pyoascites was observed in the abdominal cavity, and a stool had formed in the mesosigmoid. Perforation was detected in the sigmoid colon, and so sigmoidectomy and colostomy were performed. Ulceration with a diameter of about 3 cm was noted in the sigmoid colon, and perforation with a diameter of about 1 cm was detected at the base of the ulcer. Hematoxylin-eosin study revealed the perforated site was covered with granulomatous tissue. Infiltration of inflammatory cells was relatively mild. There were no changes indicating vasculitis or thrombogenesis in intramural and mucosal vessels. A corticosteroid-induced ulcer should rather be considered as the cause of colon perforation in this case.

Key words
systemic lupus erythematosus, intestinal perforation, steroid

Reprint requests
Masaki Hata Department of Coloproctological Surgery, Juntendo University School of Medicine
2-1-1 Hongo, Bunkyo-ku, 113-8421 JAPAN

Accepted
December 16, 2005

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