ステロイド長期投与例の腹部救急疾患の治療戦略　　ステロイド投与中の腹部救急手術症例の検討

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  • Management of Acute Abdomen in Patients Receiving Glucocorticoids

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Sabjects were 18 patients receiving glucocorticoids to treat rheumatic arthritis (7), progressive systemic sclerosis and dermatomyositis, systemic lupus erythematosus, malignant lymphoma (2), blood disease (3), ulcerative colitis (2), acute respirocirculatory failure, and intracranial hypertension after neurosurgery undergoing emergency abdominal surgery between 1992 and 2002. The mean daily glucocorticoid dosage was 54.5 mg for 41.9 months. Emergency surgery was done due to acute abdomen accompanying 7 infections (4 of cytomegalovirus, 2 of neutropenic enterocolitis, and 1 of tuberculosis 1), 8 worsening of the original disease (4 of ischemia of the intestinal tract were included), 2 peptic ulcer perforations, and 1 sigmoid colon diverticulum perforation. Perioperative steroid supplementation was done in 14 patients. Morbidity was 77.8%. The 35 complications involved wound infection, anastomotic failure, multiple organ failure, etc., and were observed in 14 patients. Mortality was 33.3% (6 cases). Due to high morbidity and mortality in patients taking glucocorticoids, the activity of the original disease must be evaluated prior to treatment of acute abdomen.

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