Abstract
A 65-year-old woman, with a history of systemic lupus erythematosus (SLE) and treatment with prednisolone for 5 years, was admitted to our hospital for acute abdomen. As lupus enteritis was suspected, high doses of corticosteroid therapy were given. This treatment resulted in transient improvement, but fecaluria and intestinal fistula developed. Endoscopic and radiological examination showed vesico-sigmoid colonojejunalcutaneous fistula. As physical examination and laboratory findings did not reveal increased activity of SLE, fistulectomy, rectosigmoidectomy and colostomy (Hartmann’s operation) were performed after steroid tapering. Histopathological findings of the resected specimen showed inflammation of intramural vessels and were compatible with lupus enteritis. After operation, she had an uneventful clinical course. Since intestinal perforation in SLE is rare and has a grim prognosis, careful management of steroid and timing of operation are important.
