Mechanical bowel strangulation mimicking mesenteric vasculitis in a systemic lupus erythematosus patient.
A case of systemic lupus erythematosus with jaundice and vague abdominal pain which did not respond to steroid pulse therapy is presented. Noninvasive examinations and imaging studies showed ileus. Two weeks later, an emergency laparotomy was performed because of severe refractory abdominal pain and hemodynamic decompensation. An ischemic part of the terminal ileum was resected. It was pathologically determined to be ischemic bowel disease because of mechanical strangulation resulting from adhesion band, but without evidence of vasculitis, atherosclerotic change, or thrombosis. After intensive postoperative care, the patient gradually recovered. This unusual case shows that nonlupus-related mechanical strangulation should be considered in the differential diagnosis of acute abdomen in lupus patients, particularly in those who have received steroid therapy or have a history of previous abdominal operation.
Lin
Cheng-Jui
CJ
Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
Lee
Chyou-Shen
CS
Tseng
Hsiang-Kuang
HK
Chang
Yuan-ching
YC
D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008643:Mesentery / Q000098:blood supply; D014657:Vasculitis / Q000175:diagnosis