Scleroderma (Progressive Systemic Sclerosis) with Severe Bowel Involvement. Treatment by Extensive Resection of the Small Intestine

Abstract

A 48-year-old man with previously diagnosed scleroderma with bowel involvement was admitted to hospital with severe malnutrition attributed to malabsorption. Shortly after this, he developed features of intestinal obstruction followed by paralytic ileus. Due to failure to respond to medical treatment, operation was carried out. On two occasions adhesions were divided, but the bowel failed to function. At a third operation the proximal half of the small bowel below the duodeno-jejunal flexure was excised. Following this the patient made a good recovery. Small bowel involvement in scleroderma is discussed. Malabsorption is probably related to bacterial proliferaiton in the small bowel secondary to stasis and may be helped by antibiotic drugs. Other disturbances resulting in inability of the bowel to propel its contents may comprise syndromes of obstruction and paralytic ileus. Although management of scleroderma bowel involvement is usually medical, surgical treatment may be indicated under certain circumstances. It may be life-saving.