Abstract
An 81-year-old woman was hospitalized due to abdominal pain and vomiting. She had undergone abdominal surgery at 27 years of age, and pulse steroids therapy for anti-aquaporin 4 antibody-positive neuromyelitis optica at age 80. Conservative treatment of methylprednisolone at 15 mg/day has been continued. Abdominal pain worsened on the third hospital day. On laboratory examination, counts of WBC and CRP were remarkably elevated, and abdominal computed tomography revealed free air in an abscess lesion of the abdominal cavity. Emergency operation was performed under the diagnosis of gastrointestinal perforation. Although perforation was not clear, we removed the anastomosis which had been made after the last operation because these areas were most contaminated. After operation, we confirmed that the colon near the anastomosis was perforated by a foreign body ; a scrap of a soft plastic pack containing spices. Although the plastic packaging material is not likely to cause a perforation, usage of steroids and/or the anastomosis shown in this case could induce an intestinal perforation. We reported this peculiar case with a review of the literature.
