The diagnosis and treatment experience of 7 cases of colonic stercoral perforation: Treatment results of DOI: 10.3969 / j.issn.1000 O399.2009.05.034 in systemic lupus erythematosus (systemic lupus erythematosus, SLE) is characterized by multiple system and organ damage as an autoimmune disease. Clinical manifestations with acute abdomen as the main feature in SLE patients become complex, leading to clinical misdiagnosis and inappropriate treatment. Herein, we retrospectively analyzed three cases of acute abdomen caused by SLE to enhance awareness of such diseases.
1. Clinical Data
1.1 From February 2006 to July 2008, data from our hospital diagnosed three female patients with acute abdomen caused by SLE were collected. Their ages ranged from 36 to 52 years old, averaging 44 years old. Before experiencing acute abdomen, they had suffered from SLE for 3 to 67 months, averaging 28 months. After admission, they were referred to the Department of Rheumatology at Chizhou People’s Hospital. The Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score ranged from 10 to 14, averaging 12.
1.2 Clinical Manifestations and Laboratory Examinations:
All three patients had abdominal pain before developing acute abdomen; two had fever with temperatures ranging from 38.5°C to 39.3°C; two experienced nausea and vomiting; two had diarrhea; one had abdominal distension. All three patients exhibited proteinuria, decreased serum albumin, and elevated erythrocyte sedimentation rate. Two patients had renal impairment with elevated serum creatinine and decreased complement C3. Abdominal plain films showed varying levels of liquid gas shadows and incomplete intestinal obstruction in all cases. One case showed leukopenia and thrombocytopenia; another B-ultrasound of both kidneys revealed bilateral hydronephrosis and mild renal pelvis dilation; one case had increased white blood cell and neutrophil counts, but negative blood cultures.
Change of colonic resection and one-stage anastomosis may lead to anastomotic fistula, which has serious consequences if it occurs. Therefore, the operation must be carefully conducted, strictly controlling the surgical indications. Stercoral ulcers in the colon are often multiple, sometimes inflammatory and necrotic lesions involving multiple segments of the colon, and the proximal colon is often full of feces and highly expanded. Thus, compared to lesioned colon resection plus proximal colostomy, this can reduce the incidence of perforation and fistula again. In this group of cases, four cases underwent left hemicolectomy and proximal colostomy (resection of single cavity lesions, including parts of the sigmoid colon, descending colon, and splenic flexure). Excision of highly dilated colon postoperatively will also greatly improve constipation in patients.
SPC prognosis is closely related to early diagnosis and timely surgery, and too much emphasis on diagnosis should not cause loss of the optimal surgical timing. Among the 80 patients in this group, one elderly patient was admitted late, showing signs of septic shock and severe intraperitoneal infection due to perforation. Repair of the perforation with proximal colostomy led to postoperative complications of sepsis and multiple organ failure, resulting in death. Early surgery and thorough peritoneal cavity cleansing can reduce mortality and improve prognosis. Postoperative targeted anti-infection, supportive care, maintenance of water and electrolyte balance, and protection of vital organ functions are also important measures to improve the cure rate. Colonic stercoral perforation has a high fatality rate and is prone to misdiagnosis. Raising awareness of the disease, early diagnosis, and surgical treatment are the keys. Consuming more fiber-rich foods, using laxatives, maintaining perianal hygiene, and actively treating related diseases such as rectal-anal secondary stenosis, especially in the elderly, is very important.
More articles related to topics: moncler schweiz ucd njos cjqa canada goose outlet hqc cdbt rhep abercrombie france yei xhxu isxk