Acute Abdomen in Systemic Lupus Erythematosus: The Importance of Early Laparotomy

Presented in part at the 53rd Annual Scientific Meeting of the American College of Rheumatology. Cincinnati, Ohio.
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Abstract

BACKGROUND: Acute abdomen (AA) in systemic lupus erythematosus (SLE) is a challenging diagnostic and therapeutic problem. Most patients are on steroid and/or immunosuppressive treatment and mortality is high.

METHODS: We assessed the relationship between the causes of AA in SLE and the SLE disease activity index (SLEDAI).

RESULTS: Of 51 patients with SLE and AA, 36 had active disease (Group 1) and 15 inactive disease (Group 2). Group 1 included 19 patients with vasculitis (mean SLEDAI 15.4, range 13 to 24). Three patients with intraabdominal thrombosis and high titers of anticardiolipin antibodies (mean SLEDAI 18.3) and 14 patients with non-SLE-related AA (SLEDAI 8.2, range 5 to 11). Group 2 consisted of 15 inactive SLE patients (mean SLEDAI 1.7, range 0 to 4). Mortality was high in the active group (14 patients) compared with inactive SLE (2 cases). A delay in surgical exploration (39.3 vs 178.6 hours) had a negative influence on the prognosis.

CONCLUSIONS: In SLE patients with AA, a SLEDAI score below 5 is indicative of non-SLE-related AA. Elevated aCL were found in patients with intraabdominal thrombosis. AA in inactive SLE is non-SLE-related and has low mortality, provided an appropriate surgical treatment is given. Early laparotomy influences positively the prognosis of SLE patients with AA.

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Patients and Methods

All patients with SLE and AA admitted to the Rheumatic Diseases Unit at La Raza Medical Center entered into an observational study during an 8-year period. All patients fulfilled the revised American College of Rheumatology criteria for SLE,[12]and all were hospitalized with an acute event unrelated to trauma. Patients were examined for signs and symptoms of lupus activity, abdominal pain, fever, abdominal distention, rebound tenderness, nausea, vomiting, diarrhea and abnormal peristalsis. SLE

Results

Fifty-one SLE patients (50 female, 1 male) with signs and symptoms of AA were studied. Mean age was 29.41 ± 11.00 years (range 15 to 61), and mean disease duration at the time of the acute abdominal event was 31 months (range 0 to 216).

Patients were divided in two groups according to SLEDAI scores: Group 1: patients with active disease (n = 36), and Group 2: patients with inactive disease (n = 15). Patients in Group 1 were further divided into three subgroups according to histopathological

Discussion

Gastrointestinal manifestations of SLE were first noted by Osler, who reported in 1895[16]11 cases of erythema exudativum multiforme with abdominal crises. Acute abdomen in SLE is a severe and life-threatening event that requires early diagnosis and treatment. Different studies have pointed out that vasculitis is the cause of AA in about 60% of SLE patients.8, 17, 18, 19In the present study, we found vasculitis as causing AA in only 35% of all patients. This percentage increases to 53% in

Acknowledgements

The authors gratefully acknowledge the helpful suggestions of Dr. Juan Canoso for critical review of the manuscript.

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