The diagnosis and treatment experience of 7 cases of stercoral perforation of the colon: Treatment results of DOI: 10.3969 / j.issn.1000 O399.2009.05.034 in systemic lupus erythematosus (systemic lupus erythematosus, SLE) is an autoimmune disease characterized by multiple system and multiple organ damage. The clinical manifestation with acute abdomen as the main feature in SLE patients becomes complex, leading to misdiagnosis and mistreatment. Herein, we retrospectively analyze 3 cases of acute abdomen caused by SLE to enhance awareness of such diseases. Clinical data from February 2006 to July 2008 in our hospital diagnosed 3 female patients with acute abdomen caused by SLE, aged 36-52 years old, averaging 44 years old. Before suffering from acute abdomen, the course of SLE was 3-67 months, averaging 28 months. After admission, the department author's unit: 247000 Chizhou People’s Hospital Department of Nephrology and Rheumatology. Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score was 10-14, averaging 12. Clinical manifestations and laboratory examination of the 3 cases before acute abdomen had been diagnosed with SLE and received varying degrees of prednisone and immunosuppressive therapy. All 3 patients experienced abdominal pain, 2 cases with fever, temperature ranging from 38.5°C to 39.3°C, 2 cases of nausea and vomiting, 2 cases of diarrhea, and 1 case of abdominal distension. Urinary protein was present in all 3 patients, serum albumin decreased, and erythrocyte sedimentation rate increased. Two patients had renal impairment with elevated serum creatinine and decreased complement C3. Abdominal plain film showed liquid flat shadow and incomplete intestinal obstruction; 1 case had leukopenia and thrombocytopenia, 1 case showed bilateral renal pelvis and mild hydronephrosis on B-ultrasound, and in 1 case, white blood cell and neutrophil counts increased simultaneously, but blood cultures were negative.
Change of colonic resection and one-stage anastomosis may lead to anastomotic fistula, and once it happens, the consequence is serious. Therefore, the operation must be careful, strictly grasping the operation indication. Stercoral ulcers in the colon are often multiple, sometimes inflammatory and necrotic lesions involving multiple segments of the colon. The proximal colon is often full of manure and highly expanded. Compared to the lesion of the colon resection plus proximal colostomy, it can reduce the incidence of perforation and fistula again. In this group of cases, 4 cases underwent left colon resection and proximal colon ostomy (resection of single cavity lesions, including the portion of the sigmoid colon, descending colon, and the splenic flexure of the colon), excision of highly dilated colon postoperatively will also greatly improve constipation in patients. SPC prognosis is closely related to early diagnosis and timely operation, should not overly emphasize the diagnosis and lose the optimal operation timing. In this group of 80 patients aged 1 case, due to delayed admission for septic shock performance, intraperitoneal severe infection: the perforation repair with proximal colon loop colostomy, complicated with postoperative sepsis, multiple organ failure death. Early operation and thorough cleansing of the peritoneal cavity can reduce mortality and improve prognosis. Postoperative targeted anti-infection, support, maintenance of water and electrolyte balance, and protection of vital organ function are also important measures to improve the cure rate. Stercoral perforation of the colon has a high fatality rate and is prone to misdiagnosis. Enhancing awareness of the disease, early diagnosis, and operation treatment is the key. More food rich in fiber components, laxatives, keeping perianal hygiene, actively treating related diseases such as rectal anal secondary stenosis, especially in elderly people, is very important.
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