Bautista LJN, Mayo VFC, Calderón LLM

Language: Spanish
References: 10
Page: 11-15
PDF size: 224.34 Kb.

ABSTRACT

The pseudo-intestinal obstruction (PIO) is an uncommon complication due to systemic lupus erythematosus (SLE) and its diagnosis can be challenging, especially when trying to differentiate it from other abdominal diseases. Clinical manifestations are caused by muscular, vascular and nervous damage of the intestinal walls, causing hypomotility and symptoms of obstruction. This paper reports the case of a 19 year-old woman who first manifested abdominal pain, abdominal distention and vomits, plus she had a history of inferior vena cava thrombosis and lupus. An abdominal computed tomography (CT) scan showed intestinal distention, PIO, ascites and right hydronephrosis, therefore the diagnosis of a real obstruction was rejected, and surgical intervention was avoided. The patient was treated with steroids. The response to the treatment was good, the patient went into remission, and was discharged from the hospital. 12 months later, no complications were reported. SLE with PIO is hard to detect, but the proper identification and correlation of the semiology of the case with the immunological and imaging data was decisive in the differential diagnosis with other abdominal diseases, such as the intestinal obstruction.

REFERENCES

1. Brewer BN, Kamen DL. Gastrointestinal and Hepatic Disease in Systemic Lupus Erythematosus. Rheum Dis Clin N Am. 2018;44(1):165-75.

2. Hallegua D, Venuturupalli S. Gastrointestinal and Hepatic Manifestations. En: Wallace DJ, Hahn B, Dubois EL, editores. Dubois’ lupus erythematosus and related syndromes. 8th ed. Philadelphia, PA: Elsevier/Saunders; 2013. p. 415-25.

3. Li Z, Xu D, Wang Z, Wang Y, Zhang S, Li M, et al. Gastrointestinal system involvement in systemic lupus erythematosus. Lupus. Octubre de 2017;26(11):1127-38.

4. Merlin A, Soyer P, Boudiaf M, Hamzi L, Rymer R. Chronic intestinal pseudo-obstruction in adult patients: multidetector row helical CT features. Eur Radiol. agosto de 2008;18(8):1587-95.

5. Hill PA, Dwyer KM, Power DA. Chronic intestinal pseudoobstruction in systemic lupus erythematosus due to intestinal smooth muscle myopathy. Lupus. Julio de 2000;9(6):458-63.

6. Perlemuter G, Chaussade S, Wechsler B, Cacoub P, Dapoigny M, Kahan A, et al. Chronic intestinal pseudo-obstruction in systemic lupus erythematosus. Gut. 1 de julio de 1998;43(1):117-22.

7. Leonardi G. Intestinal pseudo-obstruction in inactive systemic lupus erythematosus: An unusual finding. World J Gastrointest Pharmacol Ther. 2010;1(6):135.

8. Qiao Z, Wang L, Chen Y, Feng H, Shen J. Systemic lupus erythematosus with intestinal pseudo-obstruction as initial manifestation in a middle-aged man: a case report and literature review. Int J Clin Exp Med. 2016;9:4.

9. Ceccato F, Salas A, Góngora V, Ruta S, Roverano S, Marcos JC, et al. Chronic intestinal pseudo-obstruction in patients with systemic lupus erythematosus: report of four cases. Clin Rheumatol. 2008;27(3):399-402.

10. López CAG. Intestinal pseudo-obstruction in patients with systemic lupus erythematosus: A real diagnostic challenge. World J Gastroenterol. 2014;20(32):11443.