Diffuse Peritonitis in Steroid-Treated Patients

Abstract

Patients on systemic steroid therapy are at increased risk of diffuse peritonitis, specially from gastrointestinal perforation. We performed a retrospective study of 37 patients on systemic steroid therapy who underwent surgery for diffuse peritonitis. Clinical presentation of peritonitis was usually aspecific, making the diagnosis difficult. The median interval between onset of symptoms and surgery was 3.3 days, reduced to 2.0 days between hospitalization and surgery. The mortality rate was 46% (17 of 37 patients). We emphasize aggressive diagnostic efforts and early abdominal exploration in front of any persisting abdominal pain in patients on systemic steroid therapy.

Risk factors for reintervention after surgery for perforated gastroduodenal ulcer

“…Use of steroids and older age are well known risk factors for mortality in perforated gastroduodenal ulcer, whereas they were associated with a reduced risk of reintervention in the present study. This surprising and potentially protective effect of older age and steroid use might be related to the fact that elderly patients and those treated with steroids may display atypical clinical symptoms, which challenges the diagnosis of surgical complications. Accordingly, the threshold for suspecting surgical complications in elderly patients with perforated gastroduodenal ulcer and in patients with perforated gastroduodenal ulcer using steroids should be low, including early consideration of diagnostic tests and investigations.…”

Emaciation as a Manifestation of Acanthocephaliasis in the Common Eider (Somateria mollissima)

“…A steroid-induced immunosuppression may prevent the body from responding appropriately to other pathogens: for this reason, antifungals and antibacterials should be administrated concurrently any time steroids are used. Another caution for corticosteroid use in humans, not yet documented in birds, is the drug's ability to increase the risk of peritonitis (Menegaux et al 1998). Possible dangerous side effects of corticosteroid use must be taken into consideration when evaluating this drug as part of a treatment protocol.…”

Steroid Induced Gastrointestinal Perforation in a Traumatic Injury. Atypical Complication to a Common Drug

“…Gut perforation is a less well recognized complication of steroid therapy, difficult to diagnose and serious. Patients on systemic steroid therapy are at increased risk of diffuse peritonitis, especially from gastrointestinal perforation 5 . This case cautions readers to be mindful of an uncommon side effect of a regularly used drugs, which can be life threatening.…”