INTESTINAL PERFORATION - A COMMON COMPLICATION OF SCLERODERMA

The known intestinal complications of systemic sclerosis (SSc) stem ma inly from motor disturbances. Autopsy findings were studied to identif y anatomic abnormalities that may be associated with this disease. Des criptions of intestinal organs at autopsy were compared in 16 patients with SSc and 18 patients with systemic lupus erythematosus (SLE), a r elated disease control. There was a high incidence of perforation in S Sc (7 of 16 patients) compared to SLE (1 of 18 patients) (P < 0.05). I n SSc, perforations involved all parts of the bowel: transmural esopha geal fibrosis (after heater probe cautery), dehiscence of suture line after gastric resection, perforated duodenal ulcers (N = 2), terminal ileal ischemia, and diverticulitis (N = 2). Two Of the perforations in SSc were silent and were discovered at autopsy. The one perforation i n SLE was due to full-thickness necrosis from vasculitis. This study s uggests that the intestinal walls of patients with SSc are inherently weak; the gastroenterologist should keep this in mind when performing invasive procedures.