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Jejunal perforation complicating dermatomyositis
Donghyoun Lee1, Woo Seong Jeong2, Chang Lim Hyun3
1Department of Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju Self-governing Province, South Korea.
Introduction:
Small bowel perforation is rare in dermatomyositis (DM). However, it is associated with high rates of morbidity and mortality. In line with the SCARE criteria, we describe a case of jejunal perforation for a DM patient (Agha et al., 2018 [1]).
Case Presentation:
A 63-year-old woman had been treated for DM with high dose steroid 1 month prior to the onset of severe abdominal pain. Computed tomography (CT) revealed free air in abdominal cavity and fluid around the small bowel. She was diagnosed with small bowel perforation and underwent emergency surgery. Emergent surgery showed perforated jejunum which was resected. Pathologic reports revealed mesenteric small-vessel vasculitis with a perivascular inflammatory cell infiltration.
Conclusion:
Perforation of the small bowel for DM patients is rare. However, the early diagnosis of bowel perforation is difficult in DM because it can mimic other gastrointestinal manifestations such as ileus, ischemic colitis and peritonitis. To minimize mortality via an early diagnosis and a timely treatment, it is important to examine the patient's clinical history and employ a proper medical imaging modality such as CT even when lab findings are nonspecific and atypical.
Insights
Small bowel perforation is a rare but serious complication of dermatomyositis (DM). Early diagnosis and treatment are crucial for improving outcomes in these patients.
Area of Science:
- Gastroenterology
- Rheumatology
- Surgical Pathology
Background:
- Small bowel perforation is an infrequent complication in dermatomyositis (DM).
- This condition carries significant morbidity and mortality rates.
- This case report adheres to the SCARE criteria for clinical case reporting.
Purpose of the Study:
- To present a case of jejunal perforation in a patient with dermatomyositis.
- To highlight the diagnostic challenges and management of this rare complication.
Main Methods:
- A 63-year-old female patient with a history of DM treated with high-dose steroids presented with acute abdominal pain.
- Computed tomography (CT) revealed pneumoperitoneum and small bowel fluid, indicating perforation.
- Emergency laparotomy was performed, revealing a perforated jejunum which was surgically resected.
Main Results:
- Pathological examination confirmed mesenteric small-vessel vasculitis with perivascular inflammation.
- The patient underwent surgical resection of the perforated jejunum.
Conclusions:
- Small bowel perforation in DM patients is rare and can be challenging to diagnose due to overlapping gastrointestinal symptoms.
- Prompt diagnosis using imaging modalities like CT, alongside clinical history, is vital.
- Timely surgical intervention is essential to reduce mortality in DM-associated bowel perforation.
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