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Objective: Literature on abdominal pain in Systemic Lupus Erythematosus (SLE) emphasizes non surgical differential diagnosis. Surgical consult is often requested prior to intensification of immunotherapy. Perhaps the majority of abdominal pain in SLE patients is due to prosaic surgical illness rather than “lupus flair,” not requiring such intensification.
Design: Retrospective review of 81,362 hospital discharges in patients with SLE was performed for 5 years, 2010-2015
Main Outcome Measures: Variables included age, sex, emergency department (ED) chief complaint, admit diagnosis, discharge diagnosis, operations performed, length of stay, & discharge disposition.
Results: There were 405 admissions from 154 patients with the diagnosis of SLE; 21 males, 133 females (86%.) Average age was 56 yrs and average length of stay was 6.7 days. There were 80 (20% of total) presentations with abdominal complaints; 17/80 (24%) had nonspecific admission diagnoses and 2 (2%) had nonspecific discharge diagnoses, with no mortalities. There were 14 endoscopies (17%) and 13 surgeries (15%). Surgical procedures were for small bowel obstruction (4), cholelithiasis (2), diverticulitis (1), appendicitis (3), pancreatitis (1), enterocutaneous fistula (1), and hiatal hernia (1).
Conclusions: Among SLE patients presenting to the ED, abdominal pain was the most common complaint. The most common surgical diagnoses were small bowel obstructions, GI bleeds, diverticulitis, biliary diseases, appendicitis and inflammatory bowel disease. There were 5 negative endoscopies and no negative laparotomies in the operated group. The SLE patient presenting to the ED for whom surgery is consulted is far more likely to have a common surgical diagnosis rather than an uncommon SLE-related non-surgical diagnosis. Immunosuppression intensification for SLE patients with abdominal pain should not be begun without appropriate imaging to rule out prosaic surgical disease.