Abstract
We report a survival case of a 50-year-old woman with malignant rheumatoid arthritis (RA) complicated by multiple small intestinal perforations. The patient had been on oral analgesic therapy (diclofenac sodium 25mg) for chronic RA for 4 years. First, her appetite declined, and walking became difficult. Then she developed generalized arthralgia, and after becoming unable to walk 1 month later, she was admitted to a local hospital. Free air was noted, and she was referred to our hospital with a diagnosis of gastrointestinal perforation. Extensive necrotic perforation of the small intestine secondary to strangulation ileus was diagnosed, and approximately 2 m of the small intestine containing 3 perforation sites was resected. We tried weaning her from assisted ventilation postoperatively, but she repeatedly developed respiratory insufficiency and experienced muscle weakness in her limbs and dysarthria. Arteritis was observed in the surgical specimen, and the diagnosis was small intestinal perforation complicating malignant RA. Anastomotic failure, pneumonia, brain stem infarction, and pericarditis developed postoperatively in this case, and the patient's life was saved by steroid therapy and plasma exchange. Whenever severe arteritis complicates malignant RA and small intestinal perforation, a procedure that avoids intestinal anastomosis should be considered.
