title: Multiple ileal perforations due to regular diclofenac sodium injections: a case report.
abstract: BACKGROUND
  Although the adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs) on the upper gastrointestinal tract have been well characterized, those specific to the lower gastrointestinal tract are less clear, as only a limited number of articles and case reports exist in the literature.
  
  
  METHODS
  We describe a case of a 69-year-old woman who presented to the emergency department due to sudden onset abdominal distension and pain. Notably, she reported using intramuscular diclofenac sodium twice daily for 14 days after knee joint replacement surgery. The patient denied any other coexisting diseases. As a subsequent X-ray and computed tomography (CT) scan showed free air in the abdomen, an exploratory laparotomy was performed, revealing four free perforations in the terminal ileum. Findings on microscopic analysis were non-specific.
  
  
  CONCLUSIONS
  We report a unique case of multiple ileal perforations due to regular diclofenac sodium injections and contend that ileal perforation can be considered as a source for pneumoperitoneum with concomitant peritonitis in patients with a history of NSAID use if other possibilities are excluded.
authors.affiliation: Departments of Internal Medicine and Research Institute for Medical Science, Chonbuk National University College of Medicine, Geumam 2-dong, Deokjin-gu, Jeonju, 561-712, Republic of Korea.
authors.forename: Won Seok
authors.initials: WS
authors.lastname: Park
authors.forename: Sang Wook
authors.initials: SW
authors.lastname: Kim
authors.forename: Seok
authors.initials: S
authors.lastname: Lee
authors.forename: Soo Teik
authors.initials: ST
authors.lastname: Lee
authors.forename: Ho Sung
authors.initials: HS
authors.lastname: Park
mesh_terms: D015746:Abdominal Pain; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D004008:Diclofenac / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007082:Ileum / Q000187:drug effects*; D007249:Inflammation; D007267:Injections / Q000009:adverse effects; D007416:Intestinal Perforation / Q000139:chemically induced*; D010538:Peritonitis / Q000209:etiology; D011027:Pneumoperitoneum / Q000209:etiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac
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