全身性紅斑狼瘡合併空腸破裂－－病例報告

Systemic Lupus Erythematosus with Jejunal Perforation-- A Case Report

一位二十五歲男性全身性紅斑性狼瘡病人罹患漸進性腹部症狀包括腹瀉、腹痛、黑便、血便等，經住院檢查治療三週未果。後來施行剖腹探查手術發現空腸有缺血性變化併三處破裂孔，並有照影劑漏出，導致鋇鹽腹膜炎而終告不治。全身性紅斑性狼瘡病人約半數會罹患腹部症狀，但多屬輕微，嚴重而需要剖腹探查者，則屬少數。本例空腸破裂即是引起紅斑性狼瘡腹部症狀少見的原因之一，多為腹內血管炎所致。血管炎引起之腹部症狀初發時很難診斷，少數後期需剖腹探查時，多已發生內臟壞死或破裂而增加死亡率。對於此少見的併發症，需有高度警覺，施行腸胃道X光檢查時要選擇水溶性照影劑，並及早手術治療，始可減少死亡率。紅斑性狼瘡併發急性腹症時，如確定無內臟破裂，尚可 試行使用高劑量類固醇及抗生素，可能避免一些不必要的手術，但經十二至四十八小時未見改善或惡化時，則宜施行剖腹探查，以策安全。

We report a patient with systemic lupus erythematosus (SLE) complicated by jejunal perforation which is a rare abdominal complication in SLE and mostly a consequence of vasculitis. The early diagnosis of intraabdominal vasculitis is very difficult and the timing of laparotomy is often delayed until the appearance of typical signs of visceral necrosis or perforation. The management of this complication is challenging. A high index of suspicion, the prophylactic use of water soluble contrast agents in gastrointestinal studies and early surgery are the cornerstones of management. In SLE patients with acute abdomen, augmented steroids and antibiotics can be tried carefully after excluding visceral perforation. If there is no improvement or instead deterioration 12 to 48 hours after steroids and antibiotic treatment, laparotomy should be performed.