Perforation of the gastrointestinal tract in patients receiving steroids for neurologic disease

Fadul, Camilo E.; Lemann, W; Thaler, Howard T.; Posner, Jerome B.

doi:10.1212/wnl.38.3.348

Cited by 87 publications

(43 citation statements)

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“…Dexamethasone has been used in a dose range of 8-60 mg/day [140], and methylprednisolone has been administered in a dose range of 30-50 mg/day [31]. The potential for complications during long-term therapy, including an increased risk of bowel perforation [141,142], may limit this approach to patients with short life expectancies.…”

Section: Corticosteroidsmentioning

confidence: 99%

Adjuvant Analgesics in Cancer Pain Management

2004

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Adjuvant analgesics are defined as drugs with a primary indication other than pain that have analgesic properties in some painful conditions. The group includes numerous drugs in diverse classes. Although the widespread use of these drugs as first-line agents in chronic nonmalignant pain syndromes suggests that the term "adjuvant" is a misnomer, they usually are combined with a less-than-satisfactory opioid regimen when administered for cancer pain. Some adjuvant analgesics are useful in several painful conditions and are described as multipurpose adjuvant analgesics (antidepressants, corticosteroids, α α 2 -adrenergic agonists, neuroleptics), whereas others are specific for neuropathic pain (anticonvulsants, local anesthetics, N-methyl-D-aspartate receptor antagonists), bone pain (calcitonin, bisphosphonates, radiopharmaceuticals), musculoskeletal pain (muscle relaxants), or pain from bowel obstruction (octreotide, anticholinergics). This article reviews the evidence supporting the use of each class of adjuvant analgesic for the treatment of pain in cancer patients and provides a comprehensive outline of dosing recommendations, side effects, and drug interactions. The Oncologist 2004;9:571-591

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Section: Corticosteroidsmentioning

confidence: 99%

Adjuvant Analgesics in Cancer Pain Management

2004

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“…Although hemorrhage seems to be the most common complication from peptic ulcers in steroid-treated patients [1, 9], gastroduodenal perforation is also a well-recognized complication attributed to the use of corticosteroids [10, 11, 12]. Nevertheless, this complication occurred in only 22% of our patients.…”

Section: Discussionmentioning

confidence: 83%

“…These patients are at increased risk of gastrointestinal perforation [1], and steroid treatment at the time of peritonitis increases morbidity and mortality to a formidable level [2, 3]. Perforations in steroid-treated patients are less likely to be localized because of the anti-inflammatory effect of the steroids.…”

Section: Discussionmentioning

confidence: 99%

“…Diffuse peritonitis is one of the more life-threatening complications in corticosteroid-treated patients and is linked with high mortality and morbidity [1, 2, 3]. Perforation of peptic ulcer and perforation of colonic diverticula are the most frequent complications attributed to the use of corticosteroids although perforation of colonic diverticula appears to be underestimated in these patients [4, 5, 6, 7, 8].…”

Section: Introductionmentioning

confidence: 99%

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Diffuse Peritonitis in Steroid-Treated Patients

Ménégaux¹,

Chenard²,

Wechsler

et al. 1998

Dig Surg

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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.

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“…The risk of steroid induced gastric and small bowel perforations was reported soon thereafter (3,4). The positive relationship between colon diverticular perforation and GCS treatment is described to be more common in patients being treated with steroids for neurological disease, independent of steroid dosage (5). This increased risk, is explained by steroids causing intestinal atrophy, depletion of submucosal lymphoid patches and inhibition of the normal inflammatory reaction, leading to bacterial invasion, lack of containment and subsequent perforation (6,7,8).…”

Section: A B a Bmentioning

confidence: 99%

Cortisone associated diverticular perforation

Goethals¹

2011

Journal of the Belgian Society of Radiology

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Steroid associated diverticular perforation is a rare, potentially lifethreatening complication of glucocorticosteroid therapy, associated with a high mortality and morbidity rate. Glucocorticosteroid (GCS) use induces both an increased risk for perforation, and a delay in diagnosis, secondary to the mitigated clinical presentation of peritonitis. Case reportA 55-year-old man, who recently received high dose intravenous GCS therapy (3 x 500 mg of methylprednisolone) for an acute relapse of Multiple Sclerosis, presented himself at the emergency ward, suffering from dyspnea and abdominal discomfort. A chest X-ray demonstrated clear signs of a pneumoperitoneum with air under both diaphragms (Fig. 1A, B). The patient had no history of recent abdominal surgery nor blunt or penetrating trauma. C-reactive protein levels were elevated (67 mg/L, normal values < 5 mg/L) and there was a neutrophilic leukocytosis (16 x 10 3 white blood cells / mm 3 , 76% neutrophils). An abdominal CT scan, performed after intravenous administration of iodinated contrast, confirmed the presence of free intraperitoneal air and demonstrated diverticulosis of the recto-sigmoid with overt signs of diverticulitis and a pericolic abscess collection due to a ruptured diverticulum ( Fig. 2A, B) The patient was treated by emergency Hartmann surgery, confirming the perforated colon and abscess collection. Postoperative recovery and wound healing was without complications, despite the GCS therapy and the DiscussionAlthough this case demonstrates evident radiological signs of a peridiverticular abscess with perforation, there was a vast radio-clinical discrepancy. Both the etiology of the intestinal perforation and this paucity of symptoms can be explained by the patient's history.GCSs are known to be positively associated with an increased risk of patient returned home 6 days after surgery with planned closure of the colostomy. JBR-BTR, 2011, 94: 348-349. Patients on glucocorticosteroid therapy are at increased risk of gastrointestinal perforation. The associated morbidity and mortality of perforations in this group is increased, compared with normal groups. This difference is due to the delay between onset of clinical symptoms and treatment. In the presence of steroids, gastrointestinal perforation is more difficult to diagnose clinically because signs and symptoms of perforation are masked by the anti-inflammatory effect of the steroids. CORTISONE ASSOCIATED DIVERTICULAR PERFORATION

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Perforation of the gastrointestinal tract in patients receiving steroids for neurologic disease

Cited by 87 publications

References 0 publications

Adjuvant Analgesics in Cancer Pain Management

Adjuvant Analgesics in Cancer Pain Management

Diffuse Peritonitis in Steroid-Treated Patients

Cortisone associated diverticular perforation

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