Nonsteroidal anti-inflammatory drugs: An unusual cause of multiple ileal perforations

Mohamed Ali Sheredi,Zakaur Rab Siddiqui

doi:10.5348/ijcri-201596-cr-10557

Abstract

Introduction: In this case report, we describe a rare case of pneumoperitoneum with peritonitis due to multiple ileal perforations with a history of high doses of diclofenac sodium usage. case report: A young adult male with recent history of high doses of Nonsteroidal anti-inflammatory drugs (NsAIDs) presented in emergency department with acute onset pain in right iliac fossa with high grade fever and tachycardia for 12 hours. Abdomen was tender in the right iliac fossa with guarding. X-ray of chest showed free gas under the diaphragm. Exploratory laparotomy was done and showed multiple ileal perforations. ressection and anastomosis of the affected segment was done, both ends brought as double barrel ileostomy which was reversed later on without any complication. conclusion: High doses of Nonsteriodal anti-inflammatory drugs can cause multiple ileal erosions and perforation and should be considered in the the differential diagnosis, if other possibilities are excluded.

Highlights

In this case report, we describe a rare case of pneumoperitoneum with peritonitis due to multiple ileal perforations with a history of high doses of diclofenac sodium usage
It is proven that Nonsteroidal anti-inflammatory drugs (NSAIDs) can be harmful to the small intestine and can be associated with multiple complications, such as, small intestinal strictures, ulcerations, perforations, diarrhea, and villous atrophy
Rheumatoid vasculitis and other collagen vascular diseases are supposed to be responsible for described intestinal strictures and inflammation, patients suffering from such diseases should be thoroughly examined, as NSAIDs are usually mainstay to treat these disorders [3, 4]

Summary

INTRODUCTION

Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to have adverse effects on the upper gastrointestinal tract, its effect on the small intestine are not well described [1]. The NSAIDs can have adverse effects in any part of the gastrointestinal tract including, oesophagus, stomach, duodenum, small intestine, or colon [2, 3]. Risk is increased with age, in first three months of treatment, smoking, associated cardiovascular or respiratory disease, high dose and multiple NSAIDs, and concomitant use of anticoagulant or steroids [1, 3]. We report a case of NSAID-induced multiple small bowel erosions and perforations that involved the proximal as well as distal ileum. A chest X-ray showed free air under the diaphragm on the right side and an emergency laparotomy was performed for suspected peritonitis associated with intestinal perforation. After six weeks ileostomy reversal was done without any complications and remained healthy till (six months postoperatively)

DISCUSSION

CONCLUSION