Case Report of Twice Perforation of the Large Bowel During Treatment for Rheumatoid Arthritis

Abstract

A 53-year-old woman who had been treated for rheumatoid arthritis (RA) with steroid, methotrexate and NSAIDs visited to our hospital with abdominal pain in February 2004 . The emergency operation was performed under diagnosis with the perforation of sigmoid colon and the multiple ulcers of the transverse and the descending colon. Left hemicolectomy and colostomy was performed. Postoperative colonoscopy revealed multiple ulcer scars of remaining colon. Closure of colostomy and remaining colectomy was performed. After operation, treatment of RA was resumed with steroid and NSAIDs. Seven years after, she was admitted to our hospital with abdominal pain and the emergency operation was performed under diagnosis with the perforation of the remaining large bowel. The local resection of rectum was performed against the perforation of the distal colon at the ileo-colo anastomosis. Drug-induced perforation was suggested because histopathological examination revealed no special finding. We herein reported a case of twice perforation of the large bowel during treatment for rheumatoid arthritis with the review of literature.