Acute abdominal pain in patients with systemic lupus erythematosus

Omar Vergara-Fernandez*, Jorge Zeron-Medina, Carlos Mendez-Probst, Noel Salgado-Nesme, Daniel Borja-Cacho, Jorge Sanchez-Guerrero, Heriberto Medina-Franco

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Background: Patients with Systemic Lupus Erythematosus (SLE) that present with acute abdominal pain (AAP) represent a challenge for the general surgeon. The purpose of this study was to identify the major causes of AAP among these patients and to define the role of disease activity scores and the APACHE II score in identifying patients with an increased perioperative risk. Methods: We conducted a prospective study of patients admitted to the ER with AAP and SLE in an 11-year period. Demographic, diagnostic, and treatment data were recorded. Systemic lupus erythematosus disease activity index (SLEDAI), systemic lupus international collaboration clinics damage index (SLICC/DI), and APACHE II Score were analyzed. The main outcome variables were morbidity and mortality within 30 days of admission. Results: Seventy-three patients were included. Ninety-three percent were female. Most common causes of AAP were: pancreatitis (29%), intestinal ischemia (16%), gallbladder disease (15%), and appendicitis (14%). Most causes of AAP in patients with LES were not related to the disease. APACHE II score∈>∈12 was statistically associated with the diagnosis of intestinal ischemia compared to other causes. No relationship was observed between SLEDAI and outcome. Furthermore, this index did not have impact on diagnosis or decision making. Overall morbidity was 57% and overall mortality 11%. On multivariate analysis, only APACHE II∈>∈12 was associated with mortality (P∈=∈0.0001). Conclusion: This is one of the largest series of AAP and SLE. Most common causes of AAP were pancreatitis and intestinal ischemia. APACHE II score in patients with intestinal ischemia was higher than those with serositis; further studies are needed to examine whether this score may help to differentiate these ethiologies when CT findings are inconclusive. APACHE II score was the most important factor associated with mortality. Furthermore, a prompt diagnosis and an appropriate surgical management are essential in order to improve patient outcome.

Original languageEnglish (US)
Pages (from-to)1351-1357
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume13
Issue number7
DOIs
StatePublished - Jul 1 2009

Keywords

  • APACHE II
  • Acute abdominal pain
  • Pancreas
  • SLEDAI
  • Systemic lupus erythematosus

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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