Case Report

Mechanical Bowel Strangulation Mimicking Mesenteric Vasculitis in a Systemic Lupus Erythematosus Patient

Authors: Cheng-Jui Lin, MD, Chyou-Shen Lee, MD, Hsiang-Kuang Tseng, MD, Yuan-ching Chang, MD

Abstract

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.


Key Points


* Abdominal pain is a common symptom in systemic lupus erythematosus and can occur as a consequence of various causes.


* Acute abdomen is a challenging diagnostic and therapeutic issue in patients with systemic lupus erythematosus, and mortality is high because most patients are on steroid therapy.


* Nonlupus-related mechanical strangulation should be considered in the differential diagnosis of acute abdomen in lupus patients.


* Emergent operative intervention is of utmost importance in patients with mechanical bowel strangulation.

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