![]() ![]() The authors have read and confirmed their agreement with the ICMJE authorship and conflict of interest criteria. All authors reviewed and approved of the final manuscript.Īs a requirement of publication author(s) have provided to the publisher signed confirmation of c ompliance with legal and ethical obligations including but not limited to the following: authorship and contributorship, conflicts of interest, privacy and confidentiality and (where applicable) protection of human and animal research subjects. Made critical revisions and approved final version: BK, KM. Jointly developed the structure and arguments for the paper: BK, OA. Agree with manuscript results and conclusions: BK, OA, OB, NEB, KM. Contributed to the writing of the manuscript: OA. Wrote the first draft of the manuscript: BK. Gastrointestinal perforations including sigmoid diverticular perforation should always be included in differential diagnosis of patients under steroid treatment with acute abdominal pain.Ĭonceived and designed the experiments: BK, OA. The steroids increase the risk of colon perforation, specially in geriatric population. In conclusion, the number of patients treated with steroids were increased in last years. 9 They recommended LL for most of the patients with diverticular perforation. Myers E et al operated 92 patients by LL and they detected only 4 recurrent diverticulitis in 36 months follow up. 7, 8 The perforated colonic region is explorated, primarily repaired and drained without any ostomy. Laparoscopic lavage (LL) was introduced recently. This surgical procedure is a relatively invasive approach in era of laparoscopy. ![]() Sigmoid diverticular perforation was treated with sigmoid colon resection and proximal colostomy for a long time. Our patient was also taking NSAID with the steroid. NSAID also increase the perforation risk. 6 These patients are generally treated with non-steroid anti-inflammatory drugs (NSAID) combined with steroids. 5 It was stated that diverticular disease has a six times more mortality rate in patients with rheumatoid arthritis. 3, 4 Piekarek et al studied 54 patients with diverticular perforation and concluded that corticosteroids increase the risk of perforation in these patients. Sigmoid colon perforation under corticosteroid treatment was reported in the literature. The diagnosis of sigmoid colon perforation was established after 5 days of her symptoms. 2 Our patient had been admitted to the emergency room two times. Fadul et al reported that the time in between beginning of the symptoms and diagnosis of peritonitis may change 1 to 14 days in patients under steroid theraphy. The peritonitis that develops in these patients usually have a silent course due to changes in inflammatory cells after steroid treatment. Corticosteroids also disturb the intestinal mucosal defence by inhibiting prostocycline synthesis. The prostocyclines are synthesized in intestinal mucosal surface and associated with local defence. ![]() Distorded mucosal surface is prone to bacterial colonization. The h istopathological examination revealed a diverticular ulcer with perforation.Ĭorticosteroids disturb the intestinal mucosal repair system by preventing protein synthesis. There was no leakage or abscess formation in postoperative period ( Fig. The postoperative period was uneventfull. After debridation of perforated region, the defect was primarily repaired with 3/0 vicryl sutures. The multiple biopsies were taken from perforated area. The diameter of the perforation was about 0.2–0.3 cm. A small diverticular perforation on the anti-mesenteric side of the sigmoid colon was detected. In exploration, there was reactive fluid in the abdominal cavity. The patient was explorated with the diagnosis of gastrointestinal perforation. The abdominal ultrasonography revealed dilatation in small intestine with minimal intraabdominal fluid. There was free air below right diaphragm in abdominal x-ray. Rectal ampulla was empty in digital examination. In physical examination, there was rebound tenderness and muscular rigidity in all abdominal quadrants. Patient’s vital signs: Arterial blood pressue: 150/90 mmHg, Pulse rate: 110/min, Axillary temperature: 38 ☌. She was also taking diclofenac sodium 100 mgr/day. She was using prednisone 48–80 mg per day for two years. She had been diagnosed with diabetes mellitus and arterial hypertention. A 78 year-old woman presented to our emergency department with abdominal pain, nausea and vomiting for five days. ![]()
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