Treatment of Acute Abdomen in Patients Receiving Long-term Glucocorticoid Treatment

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Ten patients who had been receiving long-term glucocorticoid treatment underwent emergency abdominal surgery at our hospital between 1994 and 2002. Glucocorticoids had been administered for the treatment of rheumatic arthritis (n=5), allergic angiitis (n=2), ulcerative colitis (n=1), and blood diseases (n=2). The mean daily glucocorticoid dosage was 24 mg. Serum levels of ACTH and cortisol were low, but within normal limits. Emergency operations were performed because of an acute abdomen: 4 peptic ulcer perforations, 2 small bowel perforations, 1 ileus, 1 steroid-ineffective ulcerative colitis, and 2 colon perforations. The operative procedures consisted of a gastrectomy, 3 omental patches, 2 small bowel resections, 2 colostomies and a total colectomy. Perioperative steroid cover was performed in 9 patients. The morbidity rate was 70%. The complications consisted of surgical site infections (n=2), sepsis (n=4), abdominal ruptures (n=2), and peptic ulcer bleedings (n=2). The mortality rate was 30%. Because the general condition of patients receiving glucocorticoids sometimes worsens in spite of unclear symptoms, treatment indications for acute abdomen should be decided as soon as possible.
日本腹部救急医学会の論文