Perforation of jejunal diverticula in steroids and nonsteroidal anti-inflammatory drug abusers: a case series.
BACKGROUND
Jejunal diverticula are rare lesions, and when complications arise, they pose diagnostic difficulties. Perforation is a common complication resulting in an acute abdomen, although preoperative diagnosis is usually not possible. The "gold standard" for management for patients with complications is surgery. We present a series of patients with perforated jejunal diverticula who were on prolonged treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids for Chikungunya fever.


METHODS
There were a total of six patients, all of them presenting with perforative peritonitis, with or without shock. Plain abdominal radiogram and ultrasonogram confirmed this, although the exact site of the perforation was not diagnosed preoperatively. All patients underwent exploratory laparotomy and perforated jejunal diverticulum was found. Resection and anastomosis was performed in all cases.


RESULTS
The mean operating time was 113.5 minutes, and the blood loss was not significant. Postoperative course was uneventful except wound infection in two patients. There was no mortality.


CONCLUSIONS
Prolonged NSAID and steroid use are known to cause ulceration/perforation of the upper digestive tract and colonic diverticula. This seems to be the most likely cause for the perforation of jejunal diverticula in our series of patients. This view is supported by the absence of inflammation and infiltration of neutrophils on histopathological examination of the diverticula.
Palanivelu
Chinnusamy
C
GEM Hospital & Postgraduate Institute, 45-A, Pankaja Mill Road, Ramnathapuram, Coimbatore 641045, India.
Rangarajan
Muthukumaran
M
Rajapandian
Subbiah
S
Maheshkumaar
Gobi Shanmugam
GS
Madankumar
Madhupalayam Velusamy
MV
D000368:Aged; D018354:Alphavirus Infections / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001623:Betamethasone / Q000009:adverse effects; D002646:Chikungunya virus; D004008:Diclofenac / Q000009:adverse effects; D004240:Diverticulum / Q000150:complications / Q000601:surgery*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D007416:Intestinal Perforation / Q000139:chemically induced*; D007579:Jejunal Diseases / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000009:adverse effects
D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D004008:Diclofenac; D001623:Betamethasone; D011239:Prednisolone