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[Indomethacin-induced ileal perforation].

R F Baldonedo Cernuda1, J A Alvarez Pérez, I García Bear

  • 1Servicio de Cirugía General y Digestiva, Hospital San Agustín de Avilés, Avilés, Asturias, España. baldonedo@telecable.es

Gastroenterologia Y Hepatologia
|January 14, 2004
PubMed
Summary

Indomethacin therapy can cause severe small intestine perforations, particularly in the terminal ileum. Higher doses and longer treatment durations correlate with increased intestinal wall damage and perforation risk.

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Area of Science:

  • Gastroenterology
  • Pharmacology
  • Surgical Pathology

Background:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), including indomethacin, are widely used for their analgesic and anti-inflammatory properties.
  • Gastrointestinal complications are known adverse effects of NSAID therapy, ranging from ulcers to perforations.

Observation:

  • Two male patients presented with acute abdomen and diffuse peritonitis.
  • Perforations were identified in the antimesenteric border of the terminal ileum in both cases.
  • Both patients had been undergoing oral indomethacin therapy.

Findings:

  • Histopathological examination revealed transmural infiltration, congestion, and hemorrhage of the intestinal wall.
  • The severity of these lesions was dose-dependent and duration-dependent with indomethacin therapy.

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  • These findings indicate a direct link between indomethacin use and small bowel perforation.

    • Implications:

    • Clinicians should be vigilant for gastrointestinal complications in patients on indomethacin, especially with prolonged or high-dose therapy.
    • Early diagnosis and surgical intervention are crucial for managing indomethacin-induced intestinal perforations.
    • Further research into the precise mechanisms of NSAID-induced intestinal injury is warranted.