Acute abdomen in systemic lupus erythematosus: the importance of early laparotomy.
BACKGROUND
Acute abdomen (AA) in systemic lupus erythematosus (SLE) is a challenging diagnostic and therapeutic problem. Most patients are on steroid and/or immunosuppressive treatment and mortality is high.


METHODS
We assessed the relationship between the causes of AA in SLE and the SLE disease activity index (SLEDAI).


RESULTS
Of 51 patients with SLE and AA, 36 had active disease (Group 1) and 15 inactive disease (Group 2). Group 1 included 19 patients with vasculitis (mean SLEDAI 15.4, range 13 to 24). Three patients with intraabdominal thrombosis and high titers of anticardiolipin antibodies (mean SLEDAI 18.3) and 14 patients with non-SLE-related AA (SLEDAI 8.2, range 5 to 11). Group 2 consisted of 15 inactive SLE patients (mean SLEDAI 1.7, range 0 to 4). Mortality was high in the active group (14 patients) compared with inactive SLE (2 cases). A delay in surgical exploration (39.3 vs 178.6 hours) had a negative influence on the prognosis.


CONCLUSIONS
In SLE patients with AA, a SLEDAI score below 5 is indicative of non-SLE-related AA. Elevated aCL were found in patients with intraabdominal thrombosis. AA in inactive SLE is non-SLE-related and has low mortality, provided an appropriate surgical treatment is given. Early laparotomy influences positively the prognosis of SLE patients with AA.
Medina
F
F
Rheumatic Diseases Unit, Hospital de Especialidades Centro Médico La Raza, Instituto Mexicano del Seguro Social, México City, México.
Ayala
A
A
Jara
L J
LJ
Becerra
M
M
Miranda
J M
JM
Fraga
A
A
D000006:Abdomen, Acute / Q000209:etiology* / Q000601:surgery*; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007813:Laparotomy; D016015:Logistic Models; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents