Systemic lupus erythematosus presenting as intestinal pseudoobstruction

Munyard, Paul; Jaswon, Mervyn

doi:10.1177/014107689709000117

Cited by 12 publications

(8 citation statements)

References 3 publications

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“…For SLE-associated IPO, this systematic review identified 155 cases, reported from 38 case report studies, 27,77–113 1 case control study, 114 1 cohort study 115 and 2 case series studies. 116,117…”

Section: Resultsmentioning

confidence: 99%

Gastrointestinal system involvement in systemic lupus erythematosus

Wang

et al. 2017

Lupus

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Systemic lupus erythematosus (SLE) is a multisystem disorder which can affect the gastrointestinal (GI) system. Although GI symptoms can manifest in 50% of patients with SLE, these have barely been reviewed due to difficulty in identifying different causes. This study aims to clarify clinical characteristics, diagnosis and treatment of the four major SLE-related GI system complications: protein-losing enteropathy (PLE), intestinal pseudo-obstruction (IPO), hepatic involvement and pancreatitis. It is a systematic review using MEDLINE and EMBASE databases and the major search terms were SLE, PLE, IPO, hepatitis and pancreatitis. A total of 125 articles were chosen for our study. SLE-related PLE was characterized by edema and hypoalbuminemia, with Technetium 99m labeled human albumin scintigraphy (Tc HAS) and alpha-1-antitrypsin fecal clearance test commonly used as diagnostic test. The most common site of protein leakage was the small intestine and the least common site was the stomach. More than half of SLE-related IPO patients had ureterohydronephrosis, and sometimes they manifested as interstitial cystitis and hepatobiliary dilatation. Lupus hepatitis and SLE accompanied by autoimmune hepatitis (SLE-AIH overlap) shared similar clinical manifestations but had different autoantibodies and histopathological features, and positive anti-ribosome P antibody highly indicated the diagnosis of lupus hepatitis. Lupus pancreatitis was usually accompanied by high SLE activity with a relatively high mortality rate. Early diagnosis and timely intervention were crucial, and administration of corticosteroids and immunosuppressants was effective for most of the patients.

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Section: Resultsmentioning

confidence: 99%

Gastrointestinal system involvement in systemic lupus erythematosus

Wang

et al. 2017

Lupus

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“… 4 , 5 , 8 – 10 , 12 , 15 , 16 , 24 , 26 Gastrointestinal symptoms were the initial manifestation of SLE in 16 patients, 4 , 8 – 10 , 12 , 15 , 16 , 22 , 24 , 26 11 cases (69%) of them were misdiagnosed. 8 , 10 , 12 , 15 , 16 , 24 , 26 While only 5 cases (21%) were misdiagnosed in other 24 patients. 4 , 8 , 9 , 22 , 25 The patients whose initial manifestation was gastrointestinal symptoms were more likely to be misdiagnosed ( P < 0.001).…”

Section: Resultsmentioning

confidence: 99%

“…Eleven patients (28%) received surgical treatment as the initial treatment, 10 , 15 , 16 , 26 all of them were relapsed after surgery, and 6 of them relapsed in several weeks, 2 patients relapsed in 1 year after surgery, the others did not describe the exact time. When the diagnosis of IPO secondary to SLE was established, all the patients received corticosteroids treatment and had a good response to the corticosteroids treatment.…”

Section: Resultsmentioning

confidence: 99%

“…Notably, 10 patients (63%) had a surgery in patients whose initial manifestation were gastrointestinal symptoms, 8 , 10 , 15 , 16 , 24 – 26 6 patients had an unnecessary surgery, 15 , 16 , 25 and 3 patients had once more unnecessary surgery because of misdiagnosis. 8 , 15 , 26 Only 1 patient received surgery because of small bowel perforation.…”

Section: Resultsmentioning

confidence: 99%

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Intestinal Pseudo-Obstruction in Systemic Lupus Erythematosus

Wang

Liu

et al. 2014

Medicine

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Intestinal pseudo-obstruction (IPO) is a rare but dangerous complication of systemic lupus erythematosus (SLE) when the patient has no other manifestations except gastrointestinal symptoms. We performed 1 patient with a 2-month history of recurrent vomiting and abdominal distension. She admitted past surgical histories of cesarean section and appendectomy. A physical examination revealed tenderness in the right lower abdominal on palpation and bowel sounds were weak, 2 to 3 bpm. An x-ray and CT of her abdomen showed intestinal obstruction. The initial diagnosis was adhesive intestinal obstruction. She received surgical treatment because her symptoms had gradually become more frequent and persistent. But she vomited again 2 weeks later after the surgery. Further immunology tests indicated that she had an IPO secondary to SLE. We treated the patient with methylprednisolone pulse for 3 days and followed by prednisone orally. The patient had a good response. Complete remission was achieved on 8 years follow-up.The importance of IPO secondary to SLE lies in an early diagnosis. After the diagnosis is established, immunosuppressive therapy should be the initial and first-line treatment, and surgical intervention is often disappointing and should be carefully avoided. It is necessary to enhance awareness of doctors to IPO secondary to SLE.

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“…Chronic intestinal pseudo-obstruction (CIPO) has been reported in the adult literature as an under-recognized manifestation of systemic lupus erythematosus (SLE). The pediatric incidence is not known (2)(3)(4)(5). Early identification is essential since early intervention may improve prognosis.…”

Section: Early Intervention and Resolution Of Pediatric Intestinal Ps...mentioning

confidence: 99%