Surgical complications of nonsteroidal antiinflammatory drug-induced small bowel ulceration

The association between nonsteroidal antiinflammatory drug (NSAID) intake and gastroduodenal peptic ulceration is well recognized. Recent experimental data implicate NSAIDs in the development of a similar spectrum of pathologic lesions of the small bowel. However, clinically significant NSAID-induced small bowel ulcerations have been reported infrequently. This study sought to examine small bowel complications of NSAID use requiring surgical intervention.

A retrospective study of all patients (n = 283) who underwent small bowel resection on the general surgery services at the University of Texas Southwestern Medical Center during a 3-year period from 1991 to 1994 was conducted. Patients who had a history of chronic NSAID use, no other predisposing risk factors for gastrointestinal bleeding, and pathologically confirmed small bowel ulcerations complicated by hemorrhage, perforation, or obstruction were included in this study.

Eleven patients with 12 surgical complications of NSAID-induced small bowel ulcerations were identified. These 11 patients all underwent emergent laparotomies with small bowel resection (one patient had two separate operations, 8 months apart). Small bowel ulcerations were noted to occur in the jejunum (4) and the ileum (8) and were multiple in half of the cases. Complications included bleeding (50%), perforation (33%), and obstruction (17%).

This report is the first examining a series of surgical complications of NSAID-associated small bowel ulcerations. Our data suggest that small bowel complications of NSAID use requiring surgical intervention may occur more frequently than is currently recognized and, like peptic ulcer disease attributed to NSAIDs, result in significant morbidity and mortality.