ACUTE ABDOMEN IN SYSTEMIC LUPUS-ERYTHEMATOSUS - THE IMPORTANCE OF EARLY LAPAROTOMY

BACKGROUND: Acute abdomen (AA) in systemic lupus erythematosus (SLE) i s a challenging diagnostic and therapeutic problem. Most patients are on steroid and/or immunosuppressive treatment and mortality is high. M ETHODS: We assessed the relationship between the causes of AA in SLE a nd the SLE disease activity index (SLEDAI). RESULTS: Of 51 patients wi th SLE and AA, 36 had active disease (Group 1) and 15 inactive disease (Group 2). Group 1 included 19 patients with vasculitis (mean SLEDAI 15.4, range 13 to 24). Three patients with intraabdominal thrombosis a nd high titers of anticardiolipin antibodies (mean SLEDAI 18.3) and 14 patients with non-SLE-related AA (SLEDAI 8.2, range 5 to 11). Group 2 consisted of 15 inactive SLE patients (mean SLEDAI 1.7, range 0 to 4) . Mortality was high in the active group (14 patients) compared with i nactive SLE (2 cases). A delay in surgical exploration (39.3 vs 178.6 hours) had a negative influence on the prognosis. CONCLUSIONS: In SLE patients with AA, a SLEDAI score below 5 is indicative of non-SLE-rela ted AA. Elevated aCL were found in patients with intraabdominal thromb osis. AA in inactive SLE is non-SLE-related and has low mortality, pro vided an appropriate surgical treatment is given. Early laparotomy inf luences positively the prognosis of SLE patients with AA. (C) 1997 by Excerpta Medica, Inc.