非ステロイド系抗炎症剤が原因と考えられた大腸穿孔の１例

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  • LARGE INTESTINE PERFORATION ASSUMED TO BE INDUCED BY NON-STEROIDAL ANTI-INFLAMMATORY DRUGS-A CASE REPORT-

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An 89-year-old female patient with gonarthrosis had been treated with non-steroidal anti-inflammatory drugs (NSAID) for pain due to the gonarthrosis at a nearby hospital for 6 years; the treatment included administration of indomethacin farnesil at a daily dose of 400mg and the on-demand use of 50mg indomethacin suppositories. In the mid-course of this treatment, indomethacin farnesil was changed to etodolac at a daily dose of 400mg. Since the patient had anorexia, nausea and diarrhea for 5 days, followed by hypogastric pain, she visited the hospital. She received conservative treatment with a diagnosis of enteritis, but her condition did not improve. Two days later peritoneal irritation signs initially appeared. Since intraperitoneal free air was observed on a plain x-ray film of the abdomen, the patient was referred to our department and examined. Emergency surgery was conducted with a diagnosis of diffuse peritonitis. Perforation was found at two sites of the cecum, and ileocecal resection was conducted. Serosal rubor and thickening of the wall were also observed in the center of the transverse colon. Histopathological examination revealed non-specific ulcers. After the operation, disseminated intravascular coagulation and intraperitoneal abscess developed, but the patient was cured of these complications. Colonofiberscopic examination conducted 49 days after the operation revealed a wide range of ulcerative scarring at the transverse colon. We report an uncommon case of NSAID-induced perforation of the large intestine, in which the patient's life was saved by surgery. The relevant literature is also discussed.

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