Perforation of Lower Digestive Tract Induced by Non-steroidal Anti-inflammatory Drugs; Report of Two Cases

Abstract

Nonsteroidal antiinflammatory drugs (NSAIDs) negatively affects the upper and lower digestive tract. We report two cases of perforation of the lower digestive tract induced by NSAIDs. Case 1: A 75-year-old woman reporting back pain and malaise on day 1 from her first use of lornoxicam for tendovaginitis was found in abdominal computed tomography (CT) to have thickening of the descending colon and free air in the retroperitoneal space, necessitating surgery that showed one perforation of the transverse colon and two of the descending colon. We conducted left hemicolectomy and setting of the ascending colostomy. Case 2: A 72-year-old woman reporting abdominal pain on day 7 after her first use of sulpyrine for fever was found in abdominal CT to have thickening of the ileocecal region and free air around the liver, necessitating emergency surgery that showed two perforations - one in the terminal ileum and another in the transverse colon - with serositis of the sigmoid colon. We conducted ileocecal resection and partial resection of the transverse and sigmoid colon, and setting of the ileostomy and mucous fistula. In colon perforation induced by NSAIDs, several perforations and ulcers may occur separately, requiring extensive colon resection.