Small Intestinal Perforation Caused by Enteric-coated Low-dose Aspirin

Area of Science:

• Gastroenterology
• Cardiology
• Pharmacology

Background:

• Low-dose aspirin (LDA) is widely used for secondary cardiovascular event prevention.
• Proton pump inhibitors (PPIs) are often co-prescribed with LDA to mitigate gastrointestinal side effects.
• Enteric coating is a common formulation for LDA to delay its release in the stomach.

Observation:

• A 77-year-old male with severe atherosclerosis on enteric-coated LDA and PPI presented with recurrent small intestinal perforation.
• Initial surgery for perforation was followed by a recurrence two months later.
• Discontinuation of enteric-coated LDA led to the resolution of recurrent perforations.

Findings:

• This case represents the first documented instance of small intestinal perforation directly linked to enteric-coated LDA.
• The findings suggest a potential causal relationship between enteric-coated LDA and small intestinal injury.
• Concurrent PPI use may exacerbate this risk in susceptible individuals.

Implications:

• Clinicians should consider enteric-coated LDA as a potential cause of small intestinal perforation, particularly in patients with severe atherosclerosis on PPIs.
• Further research is warranted to elucidate the mechanism behind this adverse effect.
• This highlights the importance of individualized risk assessment for aspirin formulations and associated medications.